820537_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

[Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C<outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visi#:Arrival Time: � f); Q"h Departure Time: County: _ S' - Region: a
Farm Name:' G Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: W K rd'- Phone:
Onsite Representative: Integrator:
Certified Operator: ; m Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
[] No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder 7
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P.oul
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Qther
TurkeX 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 [fNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
0 NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[J No
❑ NA
❑ NE
❑ Yes
[2-ifo
❑ NA
❑ NE
Page I of 3 21412015 Continued

'5`3 7
Facili Number: - Date of Inspection: /
Waste Collection & Treatment
'4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l 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 E�T<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a C] Yes E3<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? ❑ Yes [D'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E]"'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes [D No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 Io ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes E]"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 Drill [:]Application Outside of Approved Area
12. Crop Type(s): oeroui a!t— ��V >�-rl�r�'d y -'Ar- t Z2 v c✓73 and
13. Soil Type(s): 0 r Q z -_P--
14. Do the receiving crops diKr from those designated to the CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'flo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DIN' o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check
❑ Yes
O o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej'"Ko ❑ NA ❑ NE
Page 2 of 3 2/4/7015 Continued

34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[]'No
aciliNumber. -55-7 Date of Inspection: 7--
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
4 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 [�JNo
❑ NA ❑ NE
The appropriate box(es) below.
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 first survey indicating non-compliance:
❑ Yes
[dJ
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes E3—<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes ❑-1f6
❑ NA C—] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [31�o
❑ NA [] NE
and report mortality rates that were higher than normal?
❑ NA
[] NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes D<o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[]'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
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[dJ
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ETN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ffNo
❑ NA
[] NE
Comments refer to ueshon # E lain an YES answers::and/or an - 1^_ y""° mems' I�
( q } y : y additional recommendations or an Cher cont'
Use drawings of facilityzto`lietter explain situation§ (use additional pages as, necessary). i
i
1 Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �f- 6 az /,;7,
21412015

J'l'ype of Visit: (�"C�:ommppliance Inspection U Operation Review V (_)Structure Evaluation � Technical Assistance
Reason for Visit: 0 itoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:/o –�
Arrival Time:
❑ NA
Departure Time: County: Region:'
Farm Name:
1G
❑ NA
Owner Email:
ell
Design Current
Owner Name:
7V
Capacity
Phone:
Ca#tle Capacity Pop.
Wean to Finish
Mailing Address:
Physical Address:
Facility Contact: Eke Title: c9am Phone:
Onsite Representative: Integrator:
Certified Operator: / zY V 7— fD Certification Number: QS
Back-up Operator:
Location of Farm:
Latitude:
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)?
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?
Page I of 3
❑ Yes C�1,_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
DesignCurrent
❑ NA
Design
Current
Design Current
Swine Capacity .Pop.
Wet Poultry
Capacity
Pop.
Ca#tle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder 52)0 C'
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to WeanDesign
iurre
Dry Cow
Farrow to Feeder
D , P.oultr
Ca acit
P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (if yes, notify 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?
Page I of 3
❑ Yes C�1,_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes CE�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2015 Continued

Facili Number: jDate of ins ectioa:
Waste Collection & Treatment
4. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes 5D -No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [&No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
[a No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
1, No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Lg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fj�N0
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[- No
[DNA
E] NE
18. Is there a lack of properly operating waste application equipment?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JZ No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Waste Application
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
0,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 54_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): �LJz�/'/i'lG'�.� Qv r� >�� r r� © v
13. Soil Type(s): r.,- AUu -;
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
1, No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[- No
[DNA
E] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z� No
❑ 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
[Q,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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield p 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'ONo
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

Facili Number: - 3 Date of Inspection: AO--./ 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes (A No
` 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ &No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? D Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EkNo
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[No
if yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�jNo
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
VLNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
Callo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
2LNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
D'No
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 N ❑NE
E] NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
omments� of iaC�liu to bene ezp lam si Y � ;,and/or. any,addittonal recommendations gri�iiiyiy other ramments
( q lam an YES answers
Use drawixi �" xp _ tuatro>zs`. use additional pages=as n 'sary)
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 972 /,S/
Date: r D Jin
21412015

4 -
of Visit: ®'porout�ine
nee Inspection O Operation Review Q Structure Evaluation O Technical Assistance
m for Visit: Q Complaint Q Follow-up d Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , ` U Departure Time: ; pry County: Region: l___L'.p
Farm Name: Face 3 ri`$ 5�z Owner Email:
Owner Name:f It-- Phone:
Mailing Address:
Physical Address:
Facility Contact: f p Title: (!7lr>!7 Phone:
Onsite Representative: may— Integrator:
Certified Operator: kyr V +-- 7IDen Certification Number: /�
Back-up Operator:
Location of Farm:
Latitude:
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)?
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 Wo [] NA - ❑ NE
❑ Yes
❑ No
Design Current
❑ NE
Design
Current
Design Current
❑ NE
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I ILayer
Dairy Cow
Wean to Feeder
p /pa
]Non -Layer
DaE Calf
Feeder to Finish
Farrow to Wean
Design
Current
Daig Heifer
Dry Cow
Farrow to FeederD
, P,oult .
Ca aci
P,o
Nan -Dairy
Farrow to Finish
Gilts
Boars
Layers
Non -Layers
Pullets
Turke s
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Other
Turkex Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Wo [] NA - ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[D Yes
❑No
❑NA
❑NE
[—]Yes
allo
❑ NA
❑ NE
[] Yes
allo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: Date of ins ection: 5 La
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2r� o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? D Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E]rl�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E3"&o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
04o
❑ 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
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E'No
❑ NA
- ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R2 -<,o
9. Does any part of the waste management system other than the waste structures require
[:]Yes
EINo
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
Waste Application
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2rf4o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EErl'io ❑ 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 p Evidence of Wind Drill ❑ Application Outside of Approved Area
12. Crop Type(s): Z .— 00/et /i9 C" el�� In/! id/W fl/,901 /fJy
I3. Soil Type(s): ,t���2, �,d, r.r2 /
14. Do Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
04o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[= "o
❑ NA
❑ NE
acres determination?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
©-ISo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R2 -<,o
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�10
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
❑-Idb
❑ NA
❑ NE
the appropriate box.
C3 WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E]�Ro
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall O Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
2-1qo­
❑ NA
❑ NE
Page 2 of 3 2/412015 Continued

Facility Number: - Ds action: s G
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J?�No 0 NA ❑ NE
`25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes fallo [:]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 allo ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,® No []NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes M 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 ,g_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
E3,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
Q No
0 NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
8 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
E[No
❑ NA
❑ NE
Corntnents!(refier to question #} Explain any, YES,,"iwiiiia"" l/oi• any additional recommends ods�`or slay of er commenis.
. r�..{ " —Pages as necessary).=:;
Use drawiiAgs_of facility to better a "lam sltpahons nae, aydittonal
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date: ��,�J
2/4/2015

'7r 1 57��
Type of Visit: ®'Compl�pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: &, utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: % —/ Arrival Time: ,t o C Departure Time: ; p Countyi_-:'� Region:
Farm Name: 7'z' a e Owner Email:
Owner Name: TD _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1-�r'tt f p pe- Title: Phone:
Onsite Representative: Integrator: yi?13
Certified Operator:% Z— o f �'� f G p Certification Number: p
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
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 Ca No ❑ 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 3 214/2014 Continued
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
�I�
Jj�}�
Non -La er
Da' Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , l;oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
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 Ca No ❑ 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 3 214/2014 Continued

Facility Number: - =,-,- Date of inspection: 7-
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
[No ❑ NA ❑ NE
❑No E] NA E] NE
Structure 6
❑ Yes ER No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fj�j No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®,No [:]NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ELNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ELNo ❑ 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): r-;,xm 0...! O U
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R9,No
❑ NA
❑ NE
❑ Yes
[n No
❑ NA
❑ NE
❑ Yes
[D No
❑ NA
❑ NE
❑ Yes JQ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Z] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes E[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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

k'acili Number: - Date of Ins eedon:—/
Yes �?] No
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes D No ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes Ej 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
NA
List structure(s) and date of first survey indicating non-compliance:
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
26. Did the facility fail to provide documentation of an actively certified operator in charge'?
❑ Yes Ej No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes 0 No ❑ NA ❑ NE
Other Issues
❑ NA
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 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 g No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes E No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
Yes �?] No
NA
NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes allo
NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[:]Yes Z No
Ej NA
[j NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes allo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES.answers and/or any additional recommend a ionsdor any other comments
Use, drawings of�facility to better explain situatibns'(use additional"pages as necessary). 3 ALL_•
�� � �r �ovr �a�� ��� �ZOctl �DLt: alp ��m nr� �%dw 1��r•
1!77rwpz/Val
rn�
0-0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 7-
21412011
2/4/2011

r
'hype(_''Compliance of visit: (_'ompliance Inspection V Operation Review U Structure Evaluation U 'Technical Assistance
Reason for Visit: tKxoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: O Departure Time: O 4 County:,._5"ate. Region
Farm Name: Fa 4e- 3 Z107
r- Owner Email: or
Owner Name: AYy : n. np ,- Phone:
Mailing Address:
Physical Address:
Facility Contact: f (ay f� Title: Phone:
if
Onsite Representative: Integrator:
Certified Operator: Certification Number: /54 l p5 -
Back -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
F71-0
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p 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 [g No ❑ NA ❑ NE
® Yes ❑ No
0 Yes ❑ No
❑ Yes [:]No
E:] Yes � No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued
Design Current .. Design Current, Design Carrent
s
,�
"
Swine
Ca aci Poi �Wet�Po'ultry
p ty p �.
Capacity Pop" Cattle Capacity Pap.
Wean to Finish
x. -
I JLayer
Dairy Cow
Wean to Feeder
Feeder to Finish
„3JpD0 1).4-0 ..;L Non -La er
3i _
Dairy Calf
- *^ _ Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to FeederD
. Poul
Ca acity ''Po Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars,
Pullets
Beef Brood Cow
Other
..
._�► Turke s
I Urkey Poults
..,.,
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p 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 [g No ❑ NA ❑ NE
® Yes ❑ No
0 Yes ❑ No
❑ Yes [:]No
E:] Yes � No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes CB�No [DNA ❑ 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:
KLNo
❑ NA
❑ NE
❑ Yes
Spillway?:
❑ NA
❑ NE
❑ Yes
Rj No
Designed Freeboard (in):
❑ NE
Observed Freeboard (in): Y,L�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
§q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0,No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
21 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):rr>� D urC -
13. Soil Type(s):
14. Do the receiving crops differ from those dest%nated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KLNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
Rj No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �O_No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z�No DNA ❑ 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 EA No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

• Facility Number: - Date of Inspection: _ /fo --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes J�j No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
0 Yes 0 No ❑ NA ❑ NE
E] Yes ;0 No 0 N 0 N
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/lnspector Signature:
Page 3 of 3
Phone: .2,/P:-3 �
Date:
2/4/2011

M.MS �Jvs 61181L3
r
e of Yisit: Compliance Inspection Operation Review O Structure Evslnatian O Tecltnicaf Assistance
son for Visit: 1Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: (� ri_ Arrival Time: j� Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: mea w- Pd— L' &4&
J
Facility Contact: ka., Por -e— Title:
Onsite Representative:
i
Certified Operstor: I'1'1n D a,.
f—.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: U___8 _
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
E] Yes
Design Current
❑NA
i DesigUCurrerit
Design Current
❑ No
#..
Swine `"Cap ity Pop:
Wet Poultry
@spar stye Pop:
Cattle Capacity Pc►p.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
-
Design Current
Daijy Heifer
Cow
Farrow to Feeder
D P,oaf
Ca aci I'o .
Non -Dairy
Farrow to Finish
Gilts
Boars
ILayers
Non -Layers
Pullets
Turkeys
I Beef Stocker
Beef Feeder
Beef Brood Cow
Uther
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
E] Yes
0 N
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
❑ Yes C4 No
Yes [—]No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 114/2011 Continued

Facdi Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Ig
Observed Freeboard (in): qD
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5@ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes CR No
❑ NA
❑ NE
waste management or closure plan?
NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CR No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ WUP ❑Checklists [:)Design ❑ Maps [] Lease Agreements
[—]Other:
9. Does any part of the waste management system other than the waste structures require ❑ Yes FK] No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
:R No
Waste Application
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes :K No
❑ NA
❑ NE
maintenance or improvement?
22. Did the facility fail to install and maintain a rain gauge?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes N No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
NNA
❑ 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 crop's differ from those
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No
[:]Yes No
❑ Yes (a No
❑ Yes No
❑ Yes No
❑ NA
❑ NE
❑ NA
❑ NE
NA
❑ NE
NA
❑ NE
NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C@ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5 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
:R No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑t(3ea er Code
❑ Rainfall ❑Stocking E] Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
X] SIuYlgeurvey
22. Did the facility fail to install and maintain a rain gauge?
[:)Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
NNA
❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: T21, -$ 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.
CEI'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 CK 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:
❑ Yes CR No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
M1No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question,: Explain any YES answers and/or any additional recommendations or any other commeats:L
Use drawings of faeility to better explain situations (use additional pages as necessary)." 4
3. -Then har s e� dodo cAle- rat , `l -h Is is nd'��a�f -o ff
the_Sf(tefTk'
e�im cslVT.
'pa `oad-- . New s @0L Ord y s ke— 149f ewl
Q0, -walk flan war I'� �feNe- newrv1(sar4 wpie, sAl fo pwQ .
, q,Calitta�o) def In ao13, Plega uae a flewmeje-.
1, sol 140+ �Vor a ot3 yvar sei�- o% or d is nof back yek One war a'#? e Vw a eta .
Sl&d ewarcll°aeJo44n avid 0�j (o) pqfef#v&rtc-JherheJ_6i Jars
I ayf , , A s1 ��e,Surve SJR W ham- beep o d.
�Jv e, P
Plew a d 0 01 e- fn a 013 Mad a COPY 0 --the new
Sum 4o Pa( el ryH-h a mapltht will Ir k,e� ��e 4111d tswrvr ew�r�
.{fir venal S, and.. retro ac� -ta c" a o t a 04e,�o soon
60as te(oradsk
dour newchlr4 b"eJ WMIYA s 0* 0
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:�p_j? , c')013 J
2/4/2011

11
1
FacilityNo Farm Name -s P [ Com-- Date 3
Permit COC �_ O101NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
FB Dro s
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last Recorded (in)�-
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
nnI'3 -W5%.,. f- CWRQ 'f n rf/7y
Calib-Mi6n Date-
SizelesignFlow
Design Diam. (ft)
--
--��---
-rtGr rS- —aq�'�18!'c5+�'! � 1!�
Date f Crop Yield `I( r Transfer Sheets
Soil Tes j�
pH Fields Wettable Acres RAIN GAUGE
Lime Needed Q WUP, .�_� Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu -I k1- Zn -I v 1 in Inspections L/ Check Lists
Needs S (S -I<25) 120 min Insp. Storm Water
NPPdS P n WaathPr r:nflP_<,
v To* 13, Id.
Verify PHONE NUMBERS and affiliations
Date last WUP FRU a a31 6 FRO or Farm Records
Date last WUP at farm Spm Lagoon #
App. Hardware kf� Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac
- 60 Day
111111M 110110111111
.1 t_
• 111
10 A+ --� -
v To* 13, Id.
Verify PHONE NUMBERS and affiliations
Date last WUP FRU a a31 6 FRO or Farm Records
Date last WUP at farm Spm Lagoon #
App. Hardware kf� Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac
s
1
PF
v To* 13, Id.
Verify PHONE NUMBERS and affiliations
Date last WUP FRU a a31 6 FRO or Farm Records
Date last WUP at farm Spm Lagoon #
App. Hardware kf� Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac

` 01)4j rev] S !r tt ray
Type of Visit: 15Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason far Visit: t2�Routine O Complaint 0 Follow-up O Referral Q Emergency 0 Other Q Denied Access
Date of Visit: ® Arrival Time:+ Departure Time: [.Ea20 %I S 0 County: S, Region: �t —
Farm Name: Pope's Owner Email:
Owner Name: pQ Phone:
Mailing Address:
Physical Address: 0037 PA, -OU , C f 1i
Facility Contact: kay Par Title: ©ww Phone:
Onsite Representative: at POP-Integrator:
'kill 5
Certified Operator: %J14 p- Certification Number: 1 QJQS
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [-]Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes &a No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Condnued
Design Current
Design @arrant°
Design Current
Swine
Cap ity Pop.
Wet Poultryap ity P;op.
Cattle @apacity Pap.
.. ..
Wean to Finish
Wean to Feeder
La er
Layer
Dai Cow
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish
D . P,oWt , Ca nei P.o
La ars
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
O_tlier
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [-]Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes &a No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Condnued

Facility Number: 191-3 Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`?
❑ Yes
5. 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): Iq
Observed Freeboard (in): 5-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ 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
E;� 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
W No
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C@ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NJ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
•CQ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground D Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Accce�p_t�able Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): -L-,S rno0 h oLejeW
—
-
13. Soil Type(s): �iZ?I IS lS
�_P�xa
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
ER No
❑ NA
❑ NE
the appropriate box.
O WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
'FKJ No
❑ NA
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
0 Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
0 No
(DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[NrNA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility lumber: - Date of Ins ection: 7 5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑e No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
CR NA
❑ NE
❑ Yes
tR No
❑ NA
❑ NE
0 Yes [RNo ❑ NA ❑ NE
❑ Yes [aNo ❑ NA ❑ NE
❑ Yes bjNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[gNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
[R No
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ERNo
❑ NA
❑ NE
Use drawtn s.of faci[i to better explain situations {use additional; pages as necessary}, tons oranuwotber comments. I
Comments (refer. o question Explain any
YES answers an or any:.a additional recommen a
g tY PT''
-7, W�, �.�Q �ham n �F Acre it sfill oo2ry lx 6ft �-� hO�GrIJ
Is, Voytve�rv� Id I,�red
�S,Sl491, v ar CIS( 0 60 , Ll 13 - yl lla cid s��Pde� a, rx � � ` 4'
,pads md nor,, F-eIds wtor e-14c��d o, �
Charkd tlo d' 1 Aba-f I,o�rs COO 30110,,r e sr�dd 137acier,
�c Voak
i i � sl Ud saw to go i oAd-. �shal✓d be- e- z y/ �e�r 80+0A ��`c9,
;0if6 se,, +C) gal Bei h�'ect s�' o d
Wos �h eslYr� S1 e
01'etAef, no -j., 6M_b,� contrfd_ 6Mrnl Of-
C� recads, 11
Reviewer/Inspector Name: 7D on Schae 1 - Phone: qi jug ii (
�� ,e
Reviewer/inspector Signature: Date: o�Q
Page 3 of 3 2112011'

Facility No.%( -5-37 Farm Name r �T Pia 00We—Date +�3[
Permit COC O -l"' NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last Recorded in
Observed freeboard -257
Sludge Survey Date 30
Sludge Depth ft (P,.$
Liquid Trt. jAVeft
Ratio Slud e,to Treatment Volume if> 0.45
Date out of compliance/ POA? - I jq11-1
Calibration Date .2 3 4 5 6 7 8
Rin Size in
Design Flow m -
Actual Flow
Design Diam. ft
Actual Diam.
Soil Test Date(p 1COf �� { Crop Yield �'�1 Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Crime Needed 0 WUP Dead box or incinerator
Lime Applied Weekly Freeboard ✓ Mortality Records
Cu -I _Cy__Zn-I . 1 in Inspections ✓ Check Lists
Needs S (S-1<25) ,rye - 120 min Insp. Storm Water
NAPriS P Tj'IAIW% WPathPr( nips
N (lb/1000 Gal)
nim • , : ,r.:����������
. .F.7 MW
�_ IF A
a05-vy um m k1ml }y
Verity PHONE NUMBERS and affiliations ��9.79
Date last WUP FRO 02�r1D�- FRO or Farm Records
Date last WUP at farm Lagoon #_ (, a� P `0a
App. Hardware Top Dike 5`ti0 �vvm q.
Stop Pump ki=bor;;
Start Pump R,
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac

Nos ,5/vy cloo-f
s ago= � 4y�7Sp� IImj
Cay V7 ts�6�ar'
nn S�
7-75- a � 7,3
�� 9 ao1r� �gr� �
(03X0✓ I-o(46
axyll
"'�a
a
�
�3 �� Ji-
�a ars if � 33) �3

type of visit: t f'c:ompleance inspection V operation Review V strueture Evaluation U Iechnical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: psi Arrival
Time: Departure Time: �S County: Soft,Qs� Region: F)eo
Farm Name: t r Palate— late— Owner Email:
Owner Name: l_IY1 , E . 200— Itch DIN() (') _ Phone:
'Iv PODD
- '7
Mailing Address:
Physical Address: D37 R% vpl PU .
Facility Contact: vp LI fbipe— Title: r
Onsite Representative: R Pope
Certified Operator: awip, If -f yh po,Q(?
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: H B
Certification Number:
Certification Number:
Longitude:
Discharees and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes -ETNo [:]NA ❑NE
❑ Yes
❑ No
(DNA
❑ NE
[] Yes
n CuPo ent
❑ NA
❑ NE
sign Curren
'
ffieslacglc`
Swine` Ca ac
p ty � p.
Wct Ponitr yi
Pop.
Cattle Capacity Pop.
Wean to Finish
I 11-ayer
Dairy Cow
Wean to Feeder SCOD
Non La •er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
D'esign`'
Current
Dry Cow
Farrow to Feeder.
Dn Po.ultry
Ca .acitk
P,o .
Non-Dalty
Farrow to Finish
La ers
I 113eef Stocker
Gilts
Non -Layers
113cef Feeder
Boars
Pullets
113eef Brood Cow
Turke s
Other,
Turkey Pauits
Othcr
Other
Discharees and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes -ETNo [:]NA ❑NE
❑ Yes
❑ No
(DNA
❑ NE
[] Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes []No
❑ Yes Ej No
[] Yes 9No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

'w
]Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): —19 —
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [5{] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[,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
fSj No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g 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 0 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): l vD[ Isf2lall j2,27jAQV�1 "P
jjr
13_ Soil Type(s): Qf�-, IS
14. Do the receiving craps differ from those designa ed in the CAWMP?
❑ Yes
No
❑ NA
D 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
JZ No
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
15� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Co 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
[R No
❑ NA
ONE
❑ 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
[)3No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[Z NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5INo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check CR Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[gNon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: -7 -y11 f
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 ❑ No [�JNA ❑ NE
Other Issues
28. Did the facility fail to property 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 CA WMP?
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 IQ No ❑ NA ❑ NE
❑ Yes IR No ❑ NA ❑ NE
❑ Yes C -No ❑ NA ❑ NE
[:]Yes
® No
❑ NA
❑ NE
[:]Yes
S No
❑ NA
❑ NE
❑ Yes
ID No
❑ NA
❑ NE
❑Yes
NNo
❑NA
❑NE
(; q #): Explain any YES; answersditionai-oases as necessary). . i r y her com�nts.
Comments', refer to uestion and/or an additlonaLrecommendat�ons or'an of
Use drawings of.:facility to better exolam sitiei tions'(use`ad
PIe4e_ vvy- a, y o �ot/,&,�"o"'( 1V t7 �`�rr��rt- 8ti es P1e�,e clan
+fv; h oar O- la cal9 1v17ar `}at k o� i ho�� � r�f-�- i"ce s' r� b�
-+m
.- j u -��ory n 6) wt Cali Wo .
51 PIM vc6- is Yvo- k rl�q S j e ' , S I I'd w (1 n�P 0
•�, �(i i I i a, �a (l al ��- u��
9 %
��n; � � �1 o v� �- �' sao G+� 9a I Ja1s i�r► s�ih� ,
fi&, ret ordj- are j &As 7f �-
CIA onme-h4M r n
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
o�dIna 1,4oLiof-f::7ko [04,111J.
o- t) Prod utelcop.J.
7aQj .Schnfi6—....,
Phone
9'10-y33-33Gb (�4)
Date: S I6 01
214/2011

yv S
*/ S
yv S
wS
-S'
Facility No. '3A-0? Farm Name o �1 �q� t Date
Permit COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert)
Pop. Design Current FB i
Type Drops
J� h�
- t
'fibserved freeboard----�-
Sludge Survey Date Me mroai
Sludge lepth (ft)�'�----
Ratio Sludgeto Treatment Volume
7l 1l�. Irr ' Y1. AD -yy 04AM No A Irl Art} nhi(o . 1111 nPracti-, ]In�n�mn'A4r�,
Calibratim Date
Design Actual Flow
rii�------
Design .
1 1h
Soil Test Date ��i►Icy
pH Fields
Lime Needed o 5�
Lime Applied
Cu -I ✓ Zn- I�a�Zn
Needs P
Croo Yield
Wettable Acres �.
WUP /
Weekly Freeboard
1 in inspections
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
PulUField Soil Crop Acres PAN indo Max Rate Max Amt
l stye ,SG la W—S' -j4 04, D, I
a
tva
Verify PHONE NUMBERS and affiliations
Date last WUP FRO"] I 1 I0) Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac
App. Hardware

W

� I K5 ;Ns la -11040
Type of Visit WCompllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit IRoutlne O Complaint O Follow up O Referral O Emergency O Outer © Denied Access
Elate of►'isil:
i 7
Arri.al Time: F! �f}�
Departure Time: County: Region:
Far m fame:
Ie S
� yyrrs�
I DI J'Q Qfto
Owner Entail:
N�
Owner Name: 4-f1I1^��J
_
_ _ 1" o it, Phone:
Mailing Andress:
Physical Address: n j,� ![j
Facility Conlact: "��I1� Title: + t 3' " Phone No:
Onsite Representarive: integrator: _ _
Certified Operator: Olrl�Pl �P Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑o ❑` ❑" Longitude: Qo =I = n
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
50o o ?4TI ILINon-Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Tuta Poults
❑ Other
Discharttes & 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
❑
Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: lil
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 *9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'ffNo
❑ NA
❑ NE
❑ Yes
CS�Na
❑ NA
❑ NE
12128104 Continued

Facility Number: —�3 Date of Inspection UMFID
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in): 30
❑ Yes 7[2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1,:R No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
tRNo
[INA ❑ NE
through a waste management or closure plan?
lfi_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
I�FNo
[:INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
WNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
15�1 No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ yes
5a No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
R No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
lj�-No
[:INA ❑ 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) COAN) i' ?t4j✓d#_ F03t e , S
13. Soil type(s)
5
J �
14. Do the receiving crops di fer from those designatedJ ,j in the CAWMP?
Comments (refer to question
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
$allo
❑ NA
❑ NE
lfi_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
t$ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
15�1 No
❑ NA
❑ NE
JE any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. {use additional pages as necessary}:
A,
r
Reviewer/]nspector Name I-MV3d"l sc+ 1v0%�k- Phone: W 433-3300 XIL333
Reviewer/Inspector Signature: Date: o
Page 2 of 3 U 12/28/04 Continued

Facility Number: a — s Date of inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1;�'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes `E❑ NA El NE
the appropriate box. Elwup I--]ChecklistsDesi s
❑
Design ❑ Maps Other �No
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JUNo ❑ 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
19No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
2 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'5j[No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ER No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
FNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
SNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'WNo
❑ 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�allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
'RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Add,tional Commeiats andl©r�Drawtngs:
�r
3 �{, lir tt i V lei - R�e__
01C41 JCCL re eft,
7
alp 2 Of6&�r�-9s�if� �M N -
C000d 4,jl and re(ords ,
1128/04

Facil ty No.q�1-3-� Farm Name 1j Date (�l� l0
Permit ✓ COC ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert }
. --m ��--M, fff 0.40 -1 slam
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Slud a Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume r
Design Flow
!.Actual Flow
Design Wi th
, ,-----�-
clkkte soil Teqhat,q� ],'15 )Je
pH Fields �-`�-
Lime Needed
Lime Applied
Cu -1
Needs P
Crop Yield
Wettable Acres
WUP _
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes _
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
� Waste Analysis Date ����»��i' a :1�r�►� : r • �s,t�'
.� r.
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 0(aT10�, Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac
App. Hardware
asp

E

Type of Visit Q) -,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit - & Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �j Arrival Time: •►�D�F� - Departure Time: County: Region:
j�
Farm Name: Iv 'P's Pia i Pat `e Owner Email:
Owner Name: P10 Phone:
Mailing Address: !� a3 kl�r _3 y�
Physical Address:
Facility Contact: kalv Title:—Phone No: 393?73
Onsite Representative: Integrator:
Certified Operator: aorI•P3 k P- Operator Certification Number: AVA
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = v Longitude: 0 ° 0 ` 0 W
Design Current
❑ Yes
['No
Design C*urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish I
Layer
❑ Dairy Cow
❑ No
® Wean to Feeder 1 500 0
on -Layer
❑ Dairy Calf
❑ Yes
❑ Feeder to Finish
❑ NA
❑ Dairy Heifer
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
❑ Non -Dairy
❑ NA
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
ue
❑ Beef Brood Cow
-
❑Turke s
other than from a discharge?
Other
❑ Other
❑ Turkey Poults
❑ Other
dumber of Structures:
12/28/04
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
['No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance than -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
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(SNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[R�No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: a _53? Date of Inspection HIM
❑ Yes
JR No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NNo
4" Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
❑ Yes
115�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:
❑ Yes
No
❑ NA
Spillway?:
Designed Freeboard (in): q _
Observed Freeboard (in):ja
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15kNo
❑ 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
19 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
R Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding &Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop We(s) CD01-1a I KPIA ,90- WOVI,0
13. Soil type(s)
f
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
NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
9yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YE answers an d/"'' any irecoulmendahonsror any other comments.i
F { P g ..
Use drawings
of facih to better explain. sttuahons use additional " a es as neeessary)X
w
Reviewer/inspector Name l l [ `. ` Phone: I o
Reviewer/Inspector Signature: Date: 210,
122 /04 Continued

- Facility Number: qa,-53 Date of Inspection
I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
EA 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 El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
Ryes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis PSoil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�kNo
❑ NA
❑ NE
.23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
N NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5a No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
§4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
;R No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
SNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ISM
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
J�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
'0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
1, Normal " I * `th jT �m r jxo#,m re-eI YVor bafow4 �Prai a, o��
b,4tM yvt� a h1 h -o" pa) f -flow rale, -The P+V4$-,� co(Ort V* -Pow
ur v) e I P R a b 1+ Some- sof r�'is Mfrr�- Ct 10"e 400
Wed- I�c� a o^ 1 Sro allo+l '
I o� . VV I is 3 0,1 d y a Cr -e C a 110 rod- o a �� e� 9
`9 Ple e�� have Zd reed �-i,cvod q- r''Pcal �b a Dir mai wg lay
boomed (Pe I ��vs s or s��Qy r�'tS, Fo//n plo,5 `�o � r�2
ole, �P�al n; IV 4*dp aoN me + � a kw'we'�4) n1�
SQ � Gia � rva� n D`�do�e`POr S check cherr 11Ym
ryA-s [e . Prfa � j
s Ov ss �o -�r�vd'*r e r� s��aly raj ' a9
;6 S(vo e fv Y d, � I ca 15,
bC*1S ct�fl� �� �.� �, �'h enZy�
606010v� a, lay �, ,' olds 0--e Olt, Ap w'ds n J
CG&- fir'', nu°� a a;r�0� a, �I 60(1.7
1128/04

Date �i�����
Fadtlity No.) Farm Name o � U p
Permit COC OICNPDES (Rainbreaker PLAT Annual Cert )
,Pop.Type Design S Drops 4l.laL'I!I
IL
Lagoon 1 2 3 4 5 6 7
Spill a
Design freeboard
Observed freeboard in 3
Sludge Survey Date
Sludge Depth ft & % ,
Liquid Trt. Zone ft
A I
CalibrationDate
ETTIM
--------
Soil Test Date 1 l
Wettable Acres
Weather Codes —�
pH Fields
time Needed �i�f(l%(i D
WUP
Weekly Freeboard
Transfer Sheets
RAIN GAUGE -v
time Applied/
Rainfall JW 3" Z
Dead box or incinerator
Cu ✓ Zn
-..
1 in Inspections
Mortality Records
Needs P
120 min Inspections
.sG
Crop Yield
N Amt QbI1000 Gal)
Pull/Field
Soil
Crop RYE PAN Window Max Rate Max Amt
W
N&4441+�� r
�3 z •
a o
Aft
.sG
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 4 J� j Ifs P,:� `f j Qq Date last WUP at farm
FRO or Farm Records Peel GYJ&4-fth, t�. �K�
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lblac; Zn -1 3000= 213 Ib/ac
App. Hardware

g�CZ-s
wlz:z- Ca k�
El-

W T I1- los �f ---
Type
--
Type of Visit {5Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 04toutine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �Departure Time:
1Y30ACounty: Region: EAQ
Farm Name: PovesRn Palace—Owner Email:
Owner Name: V! PaDp- Phone:
Mailing Address: q1 Beaoer 12L clmeh
Physical Address:
Facility Contact: komCPO—Title: Phone No: –
Onsite Representative:
Certified Operator: +'PS ' -Pooe, _
R �
Back-up Operator:!
Integrator-
Operator Certification Number: 1gMlIi4 19105 -
Back -up Certification Number:
Location of Farm: Latitude: =0
=' = Longitude: = o =' = "
Design Current
❑ Yes
Design Current
Design Current
Swine Population
Wet Poultry
Cap acityPopulation
Cattier ,. Capacity Population
xGapacity
a. Was the conveyance man-made?
❑ Yes
❑Wean to Finish
❑ Layer
❑ NE
❑Dai Cow
Wean to Feeder
❑ Non -Layer I
❑ NA
f
Feeder to Finish
.Dry Poultry
_
- -
�-� -
Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Farrow to Feeder
❑ NA
❑ Non -Dairy
El Farrow to Finish
❑ La ers
,❑No
1�rNo
-- El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Yes
❑Beef Feeder
❑ Boars
El Pullets
❑Turke s
other than from a discharge?
• ❑ Beef Brood Co
Other
❑ Turkey Poults
❑ Other
Page I of 3
f SEuetures:
Nuor
rr
❑ Othermber
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[?'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,❑No
1�rNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: gj a —5'37 Date of Inspection
❑ NA
❑ NE
0 No
❑ NA
Waste Collection & Treatment
No
❑ NA
❑ NE
UNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19 _
Observed Freeboard (in): a3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
($No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
CgNo
❑ 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
Wo
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EgNo
❑ 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
CR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IgNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CgNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) CopilaBQ/ Y ' S
70
13. Soil type(s) W
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IgNo ❑ 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? Cl Yes
JR No
❑ NA
❑ NE
0 No
❑ NA
❑ NE
No
❑ NA
❑ NE
UNo
❑NA
EINE
-. ,.
Comments�(refer to ggestton #) _Explain any YES answersuand/ar any recommendations or°any athe�'r comments.
6Use dt awtngs of fac,Lty to betier�explaty situation's_ (use add,hoa
... P ges as necessary)•
AL
Reviewer/Inspector Name
Phone: �lp� 433-33M)C
Reviewer/Inspector Signature:
Date: &eAm,ai or
Page 2 of 3 `-' 12128/04 Continued

3
Facility Number: % a- —_140tiDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E'No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No [INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CRNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No U NA EINE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
tgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CRNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ TNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
EgNo
❑ 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
M No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
❑ NA
❑ NE
Additional -Comments and/or Drawings:ft
a4, C fes_ y n�w�e�e j �l�e2ci� week
016(rftl wl n"kio be_ Calibreses+h�f y &- H )i hill be tied -Gr baclrup.
as , wi it rid„ slLd`yesv&e 0&zme, Plete vR- n-ew'Fam 4 ta1&,1&1 a,r
aoO7 ss showed- 4,o r�F 1 i ��'oC freatrnolf -' � e
a
a 1, Irv' I l need- so 11 sor, 7 '� a009F M a f ne4A -A* IPme_,
Ple re(61_ at( rojY ev6*) no -t J vs`F weekll/ r
j e-
�:&M has- no'I' to ed.s��ce Abri �x in ►+� vvH- h;l, a "ek&-f` yo '6ollees✓
�L W 00-fsl��-
ba ve j- R new a(r'V rr �, loTO)
T� � � J � �� 1 Q1.
Page 3 of 3 12/28/04

Facility No.'U/_Farm Name
hermit ✓ COC Ll***� OIC
Date r$lapp
NPDES (Rainbreaker
PIAT Annual Cert)
Freeboard
Design
•ObserySludqe Survey Date Perm Liquid (ft)
_—�_---
hjSludge Depth (ft)
_--�--.
Calibration Date 2 4 1 5 6 7 8
Desi n Flow Qar
Actual Flow Pm
Sp ray Flow 5' 5-
Design
-
Desi n Width cisy ---d
Actual Width
14411rmam PAW 3 iwl
Soil Test Date Crop Yield 'F -Nb St4+/"1 in Inspections
pH Fields Askah>,t Wettable Acres ./ 120 min Inspections
Lime Needed 6.1 ��WUP �% Weather Codes �^
Cu ✓ Zn -�^j Rain Gauge Transfer Sheets
Needs P AM gWeekly Freeboard -� !
4t ir ht tirkI_ I iiClOfzainfall 41;1 � 11S' is lin IOU U 9 )17107
Waste Analysis Date j
- 60 Da
+ 60 Da
N Amt Ib11000 Gal1,5-
pH -4.._ '?. H 1 _ MDS-
I Pull/Field I Soil I Croo I Pan I Window f
ue, 4*Lp�--jT.Qq js43jq I
17. oaa%a$qq
_5e
pf Pep, Ig fit 4k !
11A 's1o'6 —a, reels Aow-
sa-qa a
Iq# Im 0 516414,

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- - - — O Other Agency
�J
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 9 Arrival Ti a a; Departure Time: Qlf : County: c�AM19SO-1 Region:
r
Farm Name: P.t:� S t )h Owner Email:
Owner Name: `^ La'I-e-s r A _ Phone:
Mailing Address:
Physical Address:
Facility Contact: C61Rtez 64 _ _ Title: Phone No:
Onsite Representative: Integrator: f% S
Certified Operator: ie Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=A
=66 Longitude: = e 0 I
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
❑ Other _
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
`-o ( I' ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges S; 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 -[Wade?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design
Cattle Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEX Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d, Does discharge bypass the waste management system'? (If yes, notify DWQ)
2- Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
[ONA
❑ NE
❑ Yes
❑ No
;RNA
❑ NE
❑ Yes
❑ No
�j NA
EINE
❑ Yes
�i No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
1.2/18/04 Continued

Facility Number. — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No INA ❑ NE
Scture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 if
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo
❑ Yes
[:1NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
[INE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
1j No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
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)
No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
(� No
❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1p 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)
13. Soil type(s)
14. Do the receiving crops Affer from those designated in the CAWMP?
❑ Yes
lWo
[INA
[INE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
wFil or,
o-m-�
Reviewer/Inspector Name ` Phone: 'f500
Reviewer inspector Signature: Date: YZ&_421 j
12/28/04 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J5 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 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
41 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fflNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
K3 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R3 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
EZNo
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up () Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: I 6%r ,K County: 1 Region:
r
Farm Name: 0 y pQlQ Ce. Owner Email:
Owner Name: Ume5 �� Phone: ('910) 38S 773{!
Mailing Address: q [ &-Qtte- 94Utn-lo, , 11.1 C a$3a$
ro7a3 1�eener Rd. < x-83
Physical Address. 4 _ � OaT^_�
Facility Contact: Title: Phone No:
Onsite Representative- S L+ _ _ Integrator: Pre .MILk" S-fCLA4Wd
Certified Operator: Operator Certification Number: j"lj 0L
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =' 0 Longitude: 0 o E_-1' = u
Swine
❑ Wean to Finish
RWean to Feeder
11
Design Current
Capacity .Population
57000 S
Wet Poultry
❑ Layer
❑ Non -Layer
Design Current
Capacity Population
DesignCurrent
CattBe Capacity Population
❑Dai Cow
❑Dai Calf
EMI Feeder to Finish❑Dairy
Heifer
❑ Farrow to WeanDry
❑ Yes
Poultry
J Y
❑ D Cow
❑ Farrow to Feeder
❑ Yes
❑ No
"' `" -''`
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Yes
❑Non -La ers
NA
❑ Beef Feeder
❑ Boars
❑ Yes
El Pullets
❑ NA
❑ Beef Brood Cwxj
-❑
%0.
Turkeys
❑ NA
❑ NE
Other
El Other
` 4
—�_
Turkey Poults
El Other
Number of Structures:
L J�
Page I of 3
12/28/04
Continued
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
N NA
EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1p 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
® No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — ��
Date of Inspection o 0
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): q ��
Observed Freeboard (in): 3 �u
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ;3 NA ❑ NE
Structure 5 Structure 6
❑ Yes N No ❑ NA ❑ NE
❑ Yes E] No [:INA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 21 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes n No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
pDrift El Application Outside of Area
12. Crop type(s) 5rnSee''l
al ( &tt , 0var
ed � 'rt A &,V-rK a ?Or,+ �^e
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. is there a tack of properly operating waste application equipment?
❑ Yes (9 No
❑ Yes 0 No
[__1 NA 0 N
❑ 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):
1
Reviewer/Inspector Name Phone � �✓.VO
Reviewer/Inspector Signature. Date: l / /040
Page 2 of 3 12/28/04 Continued

1
Facility Number: a—,3q Date of Inspection W02:1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;& No [INA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 01 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [:1 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ig No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P 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
;9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[$9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
K No
❑ NA
❑ NE
Additional Comments and/or Drawings:,,,mr c
a
Page 3 of 3 12/28/04

Ii
Iq
Type of Visit 4D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: - D Arrival Time: Departure Time: County: 4b.141 a.)— Region: riPO
Farm Name: pa 40 0 s10, Pa /Ja a e Owner Email: .....
Owner Name: C r leA 10 Phone:
Mailing Address: '1/ Q v Roa oL C %%,Tor► NL
Physical Address:
Facility Contact: _ ht r lcs poke Title:
Onsite Representative: ( Ro
oae
Certified Operator: _C �►uelt s I°A�oe _ _
Back-up Operator:
Location of Farm:
Ceq
Phone No: °i/O -3XS_ '=' Z/
Integrator: �rtM • r+ -r .S f o„ a%,
Operator Certification Number: _191%2(a
Back-up Certification Number:
Latitude: =0
� Longitude: = ° u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Layer
i
❑ Non -Layer _
❑ Wean to Finish
'9w7ean to Feeder p o0 oG
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts f
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design .: Current
Capacity Population
❑ Dairy Cow
I
❑
Dairy Calf
❑
Dairy heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: El;.
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 2rNo ❑ NA ❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
u 1V o
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
RNo
❑ Yes
E'No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
11/18/04 Continued
10

■.
it
Facility Number: 6 — S3 Date of Inspection
[rNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Waste Collection & Treatment
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[3� o
❑ NA ❑ NE
maintenance or improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: !
❑ FAN ❑ 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
Spillway?: ',2,
5 7 1-
--12.
Designed Freeboard (in): a `1 y
13. Soil type(s)
Observed Freeboard (in): 33-7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[]'Ivo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9-1Qo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
2No
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ONo
❑ 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
ErNo
❑ 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
[3� o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElLJ Yes
�,/
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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
5 7 1-
--12.
12. Crop type(s) in11rt �i
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[]'Ivo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9-1Qo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes
[3'1\ o
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
[jNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
2No
❑ NA ❑ NE
Please leeele ah a ye- n., /Ae 50.,41!/ A.,...r t'a.,e usrK
Jag son,
Reviewer/Inspector Name � G fl y Phone: cit. - IYA - rel ed 93
Reviewer/Inspector Signature: Date: ,7,/ S`
12128/04 Continued

Facility Number: Date of Inspection F3 'll�oS
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LTJ 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 appropirate box. `x,�
El�l ❑Checklists ❑ 9R!rign ❑ EJ Other
21. Does record keeping need improvement? If yes, check the appropriate bo below. �'es ❑ No E:1 NA [INE
1a- to —> r.1 /o -1.r -h 2 i -;o � 1.7 6-1-.7 7
❑ pp ication ❑ meekly Fr -ea oard ❑ sts ❑ Soil sis ❑ Was nsfers ❑ Annual Certification
X�
❑ RaiftHt ❑ wig OCropYield ❑
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 fai I 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
['No
❑ NA
❑ NE
❑ Yes
❑ No
2<A
0 NE
❑ Yes
❑ No
❑ NA
ZNE
❑ Yes
❑ No
❑ NA
OKE
❑ Yes
0"Na
❑ NA
❑ N -F
❑ Yes
❑ No
❑ NA
2<E
❑ Yes
LTJ No
❑ NA
❑ NE
❑ Yes
�Vo
❑ NA
❑ NE
❑ Yes 20No ❑ NA ❑ NE
❑ Yes
[,],'mo�o
El NA
El NE
Yes
El_
� No
❑ NA
❑ NE
❑ Yes
2To
❑ NA
❑ NE
Additibaal Comments and/or Drasviings: ,
�1 Cr000 ri /d/ f r,.c. P/eose-b
Svfe o C�-7,0/e% 74-Ae-4,1,1 4er1r'cai.',m .leap
G Co/Y For >a-0- TeGolws,f
P�e4j,, f� �� �f,G 2kR-f >�mr.. �or �e /�o rh,;,�G �nS�Gcf.'o„s,
12/28/04

Type of Visit (5 Compliance Inspection O Operation Review O Lagoon E=valuation I
Reason for Visit 19/Routine O Complaint O Follow up O Emergency Notificajop O Other ❑ Denied Access
Facility Number Date of Visit: une: % . 8 a
0 Not O erational O Below Threshold
U'Permitted [Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: - -•- - —•
Farm Name: .......M....!... ._ T�u4G+C..... _ _ _ County:~'C'''�°Sa�
Owner Name: ..__._. _ �s ..... .... Phone No: J.-.3!.� ....
.Mailing Address:... .. ............ - �!!t ie Rd . �itii`i ------ f C a�g�aS
Facility Contact: -- r• L Title: d r Phone No:
......................_. - ..... '---t .............................._... ....
Onsite Representative:......,, •• . _ _ .__ ._ .... Integrator:
Certified Operator: „Jro1-d->! 5 O rator Certification Number.
.........._.........�..._ ._....... - pe
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• �' �"
Discharg & Stream Impacts
L Is any discharge observed from any part of the operation? ❑ Yes BNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 931�40
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 02f4o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Identifier:
Structure 2 Structure 3
Structure 4 Structure 5
❑ Yes Eif-io
Structure 5
Freeboard (inches):
12112103 Continued

I, Facility Number: :�:t — �37
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 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes QNo
❑ Yes Bfgo
❑ Yes &Ko
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes BNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [fio
elevation markings?
Waste ApWication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2 bio
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes UNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes QNo
b) Does the facility need a wettable acre determination? ❑ Yes ['io
c) This facility is pended for a wettable acre determination? ❑ Yes eNo
15. Does the receiving crop need improvement? ❑ Yes 2NO
16. Is there a lack of adequate waste application equipment? ❑ Yes 131No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 53"No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ErNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [v�No
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 2No
Air Quality representative immediately.
;Comnats {rete to question)Expiaut any YFS answer andfor aayp as or any other comemr�.�-
- — _ Y
.Use drawtngs;of fac�tty to better explain site:at<ou�. {n a adeiitRonal pages as necessary} >teld COPY ❑ Ftnai Notes
At: IC .
4
-
T
Reviewer/Inspector Name _ z _
Reviewerllnspector Signature: Date: V�
12112103 Continued

• Facility Number: Ta — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
(P 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 2No
❑ Yes Ef No
❑ Yes [.]'1Clo
❑ Yes [rlo
❑ Yes [110
❑ Yes Olio
❑ Yes [Ko
❑ Yes [..-No
[:]Yes 214o
❑ Yes Bfio
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
AT !e OA F K)� 314 LJ
�
41 ss.
H,
12/12/03

Site Requires Immediate Attention • N D
Facility No. 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �3 h` , 1995
Time: �3I
Farm Name/Owner: e n r
Mailing Address: 1 t-3 A LrL.
cotmty:
Integrator: � � c�s�n � _
On Site Representative:_ ��tit _��_� C,
Physical Addmss/L.ocation: tA A
me: S foo - z
Phone:—_
Type of Operation: Swint Poultry Cattle
Design Capacity: c. So La Number of Animals on Site: E ram s �=+;
ADEM Certification Number: ACE DEM Certification Number: ACNEW
Lidaide: ° • « Longitude:_ ° • w
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 !tour storm event
(approximately 1 Foot + 7 inches) Yes or No AcLLW Frwboard:�_Ft. v Inches.'
Was any seepage observed from the lag n(s)? Yes No Was any erosion q ed? Yes oir No
Is adequate land available fol ray?Yes"or No Is the cover cr equate? �'es or No
Crop(s) being utilized: `_ �1 { - FjrrU
Does the facility meet SCS minim setback criteria? 200 Feet from Dwellings!, Yes ,or Na
100 Fact from Wells? (Yes 1gr-Np
Is the animal waste stockpiled within 100 Feet of USGS Blue Lane Stream? Y No')
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blueljne: Yes or No
Is animal waste discharged into waterc state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management repords, (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop). Yes No
Additional Comments:
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.