820546_INSPECTIONS_20171231

NORTH CAROLINA
Deprtment of Environmental Qual

tSIC;r7
S +{
Type of Visit: OC
Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ', I �q Arrival Time: IS Departure Time: County: Region
Farm Name: c,( 0-q�( Owner Email:
Owner Name: G Phone:
Mailing Address:
Physical Address:
Facility Contact:,. Title: Phone:
Onsite Representative: I l Integrator:
Certified Operator:
`l
Back-up Operator:
Location of Farm:
Certification Number: R (J(
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there Any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D -I.6 L] NA ❑ NE
❑ Yes ❑ No 'Q -NA ❑ NE
❑ Yes ❑ No ETNA ❑ NE
❑ Yes ❑ No
❑ Yes �o
[:]Yes DIN -o
DNA
Design Current
❑ NA
:Design
Current
Design CIIrrent
Swine
Capacity Pop.
Wet Poultry.
Capacity
Pop.
C:'attle Capacity op.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
3_1,
Non -La er
Dairy Calf
Feeder to Finish
Design
Current
Dairy Heifer
Farrow to Wean
Cow
Farrow to Feeder
Dr. 1'ottl "
Ca" �uci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
113eef
Boars
Pullets
Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there Any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D -I.6 L] NA ❑ NE
❑ Yes ❑ No 'Q -NA ❑ NE
❑ Yes ❑ No ETNA ❑ NE
❑ Yes ❑ No
❑ Yes �o
[:]Yes DIN -o
DNA
❑ NE
❑ NA
❑ NE
❑NA
ONE
Page 1 of 3 2/4/2015 Continued

f
Facili Number: - Date of Inspection: 13
Waste Collection & Treatment
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EjNrt' ❑ NA ❑ NE
a. If yes, is waste level into the structurhl freeboard? ❑ Yes ❑ No [2>)t- ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway9:
Designed Freeboard (in):
Observed Freeboard (in): ys
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?
❑ Yes � ❑ NA ❑ NE
❑ Yes []'NO ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0,Ko ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [:]Yes IJ g"' ❑ 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 ED -No'
❑ NA
❑ NE
maintenance or improvement?
,
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [D -5o_
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): %q '5 60
13. Soil Type(s): �P��J. b J"w Et��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Ej o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes F -4 -Ko—
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rN9
❑ NA
❑ NE
Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes B No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [-]Yes 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 311qo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes ['No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
E] NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ens ection: !
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U4 -<o
❑ NA ❑ NE
15. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E2,<o
C] NA ❑ NE
the appropriate box(es) below.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
[] NA
❑ NE
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[lf'No
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[B<
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C3 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes D -IG ❑ 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
EfNo
❑ 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
[j�o
[] 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
[lf'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
C3 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[:T'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
Ea No
❑ NA
❑ NE
Commentsj(refeir *2—n,-# AD Explain any YES;snsWers and/or.any additional- recommendations'vr any, a' codtments.$'
^9fNM, -. _).JE
_I,Yn } ':•I 25'... Fir C
Use drawin�s;of facility totter�exPlam situations'(tise additional. pages as necessarY)•' "y
Reviewer/Inspector Name:
Reviewer/Inspector Signat
03 3-3 33 `
i L Phone:
ure: Dater
Page 3 of 3 2/412015

type of visa: k7uom Mance inspection U operation Keview U structure !Evaluation U i eCnmCai Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
Departure Time: County:
�
-'Email:
_J14- Region:Kv
Farm Name:
Cattle
�NA
Owner
.,� ,
Wean to Finish
Layer
Dai Cow
I V
Owner Name:-GLj
Non -La cr
Phone:
Feeder to Finish
y
Dai Heifer
Mailing Address:
Physical Address:
ff V
Facility Contact: G44 al Title: Phone:
Onsite Representative: ( Integrator: _
Certified Operator: Y Certification Number: 1 ff13 +
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
, Design Current
Desrgn Current
Swine Capacity Pop.
Vet PoultryCapactty Pop.
-_
Cattle
�NA
❑ NE
.,� ,
Wean to Finish
Layer
Dai Cow
I V
Wean to Feeder —
Non -La cr
Dai Calf
Feeder to Finish
y
Dai Heifer
Farrow to Weana
u'
t- �-� Current.
Designer
Dry Cow
Farrow to Feeder
'D�, P,o.ult Ca' actt_4P10
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys-
S
Otber
Turkey Poulis
.Fi •.F
>�
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application f=ield ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [ No ❑ NA ❑ NE
[:]Yes
❑No
J?rNA
❑ NE
[:]Yes
[:)No
�NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]NO [�NA [:]NE
2. Is there evidence of a past discharge from any part of the operation'? [] Ycs [n No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [:;300'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili ,Number: 5f f 4 sA
jDate of Inspection:Z JAW
Waste Collection & Treatment ��,,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ea-< ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ETNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[rNo
[:3 NA
Spillway?:
the appropriate box.
Designed Freeboard (in):
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
Observed Freeboard (in):�
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
hio
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesNo
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
NA
❑ NE
waste management or closure plan?
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� b
❑ NA
❑ N£
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
[;IQo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet sucks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ea<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
f
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding p 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): ld7Grr!/'lii #'_1_
13. Soil Type(s): Co 0
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 L_f N' o ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [;J ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'? ❑ Yes M No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[rNo
[:3 NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

FacilityiNumber: Date of inspection:
.11 , ly
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 -Ko' ❑ NA 0 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 structurc(s) and date of first survey indicating non-compliance:
2b. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes�i❑ NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes [a/o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [�iQo ❑ NA ❑ NE
C] Yes E] No ❑ NA ❑ NE
❑ Yes ]o ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑Yes o
E3 Yes
�; o
❑ Yes Wo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explain anyy answers andlor:any, additionalyrecommendatlons*or any otiierrc6ih6M6!
IM
Ri drawings offacinty to better explain-sitnattonsr(use additional pages: as necessary) ' .�
��� L9LA - - -i - t 7
yr-'_ q" ).' - P,
S ('17, Sion
C-eff
Reviewer/Inspector Name:
Reviewed]nspector Signatut
Page 3 of 3
Phone:
Dater
2/4!201 S

Type of Visit: &-Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: .Routine 0 Complaint 0 Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit:rrival Time: Departure Time: ounty: 7� Region: I tG�(J
tl-
Farm Name: CO -4 I'd Owner Email:
Owner Name: / L' Phone:
Mailing Address:
Physical Address:
Facility Contact: Ci Title: Phone:
c
Onsite Representative: Integrator: IV4
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
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 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 aNcr❑ NA ❑ NE
[:]Yes ❑No G3,NA ❑ NE
❑ Yes ❑ No [] 'VA ❑ NE
[:]Yes ❑No
❑ Yes -[Et No
❑ Yes KNo
[rNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/1011 Continued
Design Current
Design
Guri:eot.
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
. Pop...
Cattle Capacity Pop.
Wean to Finish
I ILayer
D Cow
Wean to Feeder
G• —
INon-Layer___l
Calf
Feeder to Finish
"'�
4='r
Dairy Heifer
Farrow to Wean
Design
. rren
I Dry Cow
Farrow to Feeder
Dr. Poul
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
OtherTurke
Poults
Ocher
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 aNcr❑ NA ❑ NE
[:]Yes ❑No G3,NA ❑ NE
❑ Yes ❑ No [] 'VA ❑ NE
[:]Yes ❑No
❑ Yes -[Et No
❑ Yes KNo
[rNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/1011 Continued

I;acili .'Number: -f9 jDate of Ins ectiotf
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?:
[aUe— 0 NA ❑ NE
❑ No (KJ -#A ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5- Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes []'1�To ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
D-lqo_^
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[F] -"o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
[B Soo
❑ NA
❑ NE
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
EJ N
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
EI'No
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [I -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): t cfA S 6 V
13. Soil Type(s):L2'�
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
[B Soo
❑ 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
E3<o
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EI'No
❑ 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 CA WMP readily available? 1f yes, check
❑ Yes
L?No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [!�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E:�&0 ❑ NA ONE
Page 2 of 3 2/412014 Continued

Facili •Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R lfo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 -,Ko ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] 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 [<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [.-leo' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�eo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [!j'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Q 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 2 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 C3 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [J No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E�No ❑ NA ❑ NE
Comments (refer to question #i): Explain any YES answers and/or any additional recommendations or any other comments 5
Use drawings of facility to better explain situations -(use additional partes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ' %,JJ 3 3�
Date:
21412114

Type of Visit: (Kompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 401outine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: tXkq Arrival Time: Tp� Departure Time: County: Region:
Farm Name: (?a,-1 R�. �c t/ &aeon� Owner Email:
Owner Name:'�`� '\ c ($S/ Phone:
Mailing Address:
Physical Address:
Facility Contact: : aA Title: Phone:
Onsite Representative:
Certified Operator: %(
Sack -up Operator:
Location of Farm:
Latitude:
Integrator: tV L
Certification Number: 6 -`
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)?
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 r dl o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [31No
❑ Yes EfNo
B< ❑ NE
algA ❑ NE
lA
❑ NE
❑ NA
Design
Current
Design Current
Design Current
Swine
Capacity Pop ".
Wet Poultry
Capacrty
Popes:- _
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
b0
Non -La er
Dai Calf
Feeder to Finish
—Dairy Heifer
Farrow to Wean
u# ° - "
Design
Curren# . _
Dry Cow
Farrow to Feeder
Dir - Poultry
Ca aci
Pa .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other,,
.a
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes r dl o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [31No
❑ Yes EfNo
B< ❑ NE
algA ❑ NE
lA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/1011 Continued

t
FAe Number:Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g -1r ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes to ❑ 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"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 Io ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 040,
❑ 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 �la ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [/] No ❑ NA ❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!JlNo ❑ 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 C:]Evidence of Wind Drift E]Application Outside of Approved Area
12. Crop Type(s): Pj (& -P
13. Soil Type(s): •t' 1/-0
14. Do the receiving crops diger from those designated in the CAWMP?
❑ Yes
RXNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ba"'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ua"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E(No
❑ 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
t[fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
Cl WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes CZNo
❑ 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 e No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E� No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

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? ❑ Yes [�o ❑ 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 P No ❑ NA ❑ NE
gsof facility to:better'explain situations (use additional.pages as necessary). Y�� ther tamments
FC�-Lom`
ments (refer to question;#1)Explain any YES answersand/or,any.additional recommendations or'an o d['swm
[—]Yes
LR-'�o
❑ NA
❑ NE
Facility Number: -3 y Date of Ins ectiion:'f'
[/] No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑YesVo
❑ NA E] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�2rNo
❑ NA ❑ NE
the appropriate box(es) below.
M Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[1 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?
❑ Ycs
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
Po�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�o ❑ 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 P No ❑ NA ❑ NE
gsof facility to:better'explain situations (use additional.pages as necessary). Y�� ther tamments
FC�-Lom`
ments (refer to question;#1)Explain any YES answersand/or,any.additional recommendations or'an o d['swm
[—]Yes
LR-'�o
❑ NA
❑ NE
❑ Yes
[/] No
❑ NA
❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Caj' b rix,, h - �- Yo- f
S(cj e v L05 --t 5
Reviewer/Inspector Name: I� ti. J
Reviewer/Inspector Signature:
Page 3 of 3
q6 070
Phone: V- _j `33
Date:
Ir 21412A4

'k.
Rype of visit: L9'Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
eason for Visit: Q40utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Its `. OD Departure Time: County: e— Region: �^
IV
Farm Name:
Owner Name: C Z7 ,-
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Lam r 0, Title: raw n Y/
Onsite Representative: Integrator:
Phone:
4Yta!,E rater -
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
-- Design Gnrreut
Swine @specify Pop.
Wet Poultry
Capacity
Pop.
L
Cattle .. ....Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder 1,93 0V Ooa
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
en
Da Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113cef Brood Cow
Turkeys
-
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
[—]Yes E( No ❑ NA ❑ NE
[—]Yes ❑No
[—]Yes ❑No
[::]Yes ❑ No
[—]Yes ® No
[::]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
E] NA ❑NE
214/2011 Continued

PIP
Facility Number: f5ate of Inspection: 7-13
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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 S
Structure 6
❑ NA ❑ NE
Identifier:
[:]Yes
No
❑ NA ❑ NE
the appropriate box.
Spillway?:
❑WUP ❑Checklists []Design [] Maps ❑ Lease Agreements
[]Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
P,No
Observed Freeboard (in): _.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
�9 No
❑ NA ❑ NE
Page 2 of 3
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
eg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 AcceptableCropWindow [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 7 !J i -f—,r- jnrl�
13. Soil Type(s): /&3 42U Drt
14. Do the receiving crops differ from those designated in the CAWMP? [-]Yes C&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 12 -Yes ❑ 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?
1$. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes R] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design [] Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
P,No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
UR No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�9 No
❑ NA ❑ NE
Page 2 of 3
214/2011 Continued

Facility Number: - I Date of Inspection: —7—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EA No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
[:]Yes 5f No
❑ Yes ® No
❑ Yes S No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question.#f): Explain any YES answers and/or any additional recommendations or any other comments *l , V
Llse drawings of facility to better explain situations (use additional pages as necessary).
y
r -T.I7 r6uy G
✓'/gy p► -c- ccr� fir- L� �`�. �. 4-- 366-,
)V 471V , '4,
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 9/D_
Date:
21412011

4
Type of Visit: QTommpiiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time:1 pv Departure Time: / ; JD County: .
Farm Name a rl ,` �� z Owner Email:
Owner Name: COL4 14 Phone:
Mailing Address:
Physical Address:
Facility Contact: 4f�/l Title: ,qr�# Phone:
Region: P�Z_
Onsite Representative: Integrator: /,$I aria A-,
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design,' Current's"aw�Design Cuirrent Design Current
ty Pop.
Swine Ca ty Pop. Wct PoulrruCap t Pflp, Cattle Capaciej
w
Wean to Finish La er airy Cow
Wean to Feeder !o 305
on -Layer
airy Calf
Feeder to Finish
-� - M "" Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Dry P,outt • Ca acs Po Non -Dairy
La ers Beef Stocker
Farrow to Finish
Gilts
Non -La ers Beef Feeder
Roars
Pullets Beef Brood Cow
Turkeys
°- -'
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [;S,No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:)No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? 0 Yes ZI No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [Z[No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: - , L Date of Inspection: (p —
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
23 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
GE. 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
PS No
0 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
U 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
QD No
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &7 i l/r -f.- �i`,u��s>-y-,•�
13. SoilType(s): / ek%.-r-5 lea 11Z&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA 0 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Beguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 ® No
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes [& No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA r] NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Ins ection: —/
A 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CgNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes J'C'�"j No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes DU_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 [allo
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 2No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [21 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes jK No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 12INo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:33___)CDP
Date:
21412011

_" i_ -Tc -D tab
Type of Visit: atompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: a D Departure Time: - =3 County: w�a Region:
Farm Name: / � AJ �.S�r - Owner Email:
Owner Name: �'�/ Phone:
Mailing Address:
Physical Address:
Facility Contact: e'_011 l-/ , 9 . �k7 Title: Q Phone:
Onsite Representative:_ Integrator: /Yj/,rr`
Z1�Os-w
Certified Operator: .5Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
u,
Design
Current
Design Current
Swine Capacity,:. Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder p
Non -Layer
Dai Calf
Feeder to Finish
-'
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D�. .P,oul
Ca act
1'0
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
LEI
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
L10ther
Dischar es 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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
[:]Yes ❑No
❑ Yes No
[:)Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I 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 [RNo
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [[ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [RNo
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
[DNA ❑ NE
E] NA E] NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes '2 No ❑ NA ❑ NE
[]Yes 0 No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes [N No
❑ Yes � No
[:)Yes RNo
❑ NA ❑ NE
E] NA ❑NE
F] NA ❑NE
Comments (refer to question ft Explain any YES answers andlor any additional recommendations or any4,other comments --..,"'-
Use drawings offacilify'to better explain situations f use'additional pages as necessary).
I— ^;� „L �V__ -of g r� -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: % --3
21412011

1a
` Facility Number: - G Date of los ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): r
Observed Freeboard (in): 7
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?
[ZNo ❑ NA ❑ NE
[—]No ❑ NA ❑ NE
Structure 6
❑ Yes RNo ❑ NA ❑ NE
❑ Yes E] 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
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
a Yes
® No
❑ NA
❑ NE
maintenance or improvement?
C] Yes
® No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[3 No
❑ NA
❑ NE
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
n Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 9 a i 17..3 / Cn 1,1116 f DI -0 .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes F54 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes WfRo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
C] Yes
® 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
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to instal I and maintain rainbreakers on irrigation equipment?
[:]Yes
® No
❑ NA
❑ NE
Page 2 of 3
2/42011 Continued

Type of Visit: mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Y-.'OF27 Departure Time: e 3 County:
Farm Name:_ X405�-v Owner Email:
Owner Name: �jj ,r ! ; J y Phone:
Mailing Address:
Physical Address:
Facility Contact: 7 d Title: �;9j,U� �` ` Phone:
Onsite Representative: jr _ Integrator: Yt
Certified Operator: $'o�._c� Certification Nu er:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:74 (7
Design Current
DesignCurrent
--_ :,yDesign Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle _� Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
on -Layer
airy Calf
Feeder to Finish
' 1
*"'`
Dairy Heifer
Farrow to Wean
Design_
Current
Dry Cow
Farrow to Feeder
Q , P,oult •
Ga aci __
Ko
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turcey Poults
_
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [2'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes ❑ No
[:]Yes KNo
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2011 Continued

Facility 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Lo No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding Q Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% 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):�/, xcra�e� ,�tw r/�x" ,,1 �! `'amu -- %�/Goey J��
I ,..�
13. Soil Type(s): /Q 01, / 6-A AgL7V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [q No ❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement?IISleYes u ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes allo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B -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 F,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections [:IS ludge Survey
22. Did the facility fail to install and maintain a rain gauge? EJ Yesrvf
VN No [:] NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo 0 NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: jDate of Inspection: —
i 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
4
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes C3,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes [SNo ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [!,No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
[K No
C]NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 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
Q No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Z No
❑ NA
❑ NE
Comments -(refer to question #) Explain any YES answers and/or any additional recommendations or any other,comments '&
�
Use'drawin>s of facility to better explain situations (use additional pages as neeessar ).
/✓�n+r �aS 1.1 G u.i W✓ upr�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 i�33DP
Date:
21412011

I'll.
Type of Visit 0 Compliance Inspection 0 Operation Review CMtructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency g!SD.GW6r ❑ Denied Access
Date of Visit: Arrival Time: ,' D Departure Time: County: Region: F5
Farm Name: AJ LO V Owner Email:
Owner Name: %� - r4 Phone:
Mailing Address:
Physical Address:
Facility Contact: f fTitle: ri o� Phone No:
Onsite Representative: ��i c��-�/ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o =1 I E__1 Longitude: = ° =
Design Current
❑ No
Design Current
Design Current
Swine Capacci Population
Wet Poultry
CapacZity Population
Cattle Capacity Population
❑ Wean to FinishFo
Layer
Dairy Cow
❑ NE
Wean to Feeder 0v v -o
Non -La er
❑ Yes
❑ Dairy Calf
Feeder to Finish
❑ NE
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El
El Farrow to Finish
❑ N ers
❑on -La ers
on-Layers
❑ Beef Stocker
El Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
�� �.k ,. ::......
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
-
Ed
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes [R_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — S (� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9 No
❑ NA
EINE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): [
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CANo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® 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
EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
®No
[INA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
CR Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
BNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�I,GP�J�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [11 No ❑ NA ❑ NE
15. Does the receiving crop and/or Iand application site need improvement? 0 -Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ? ❑ Yes J4 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 E.No ❑ NA ❑ NE
7/Jt5 ; ���°-►.•- w� T � r v� x•u1 � c�-f�j r D r a �.r�.-�. F`rrr�� �,�o�`� oI.
%s"Z- Gv��t /yjQ�rL tr�vSrt+-`� > 7' U�7= Y�Z•nl l/`'�la,�_
a/Y7'�� %u I) � rZ Y �. {/`G.._ �- J\J C7 � �'►r� �'� �� tJ i4�/�1"�� �
Reviewer/Inspector Name,0-:0 , _ Phone
Reviewer/Inspector Signature: �`f� _ Date:
Page 2 of 3
12/28104 Continued
L.

Facility Number: — Date of Inspection
Re ua ired 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 CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No []NA ❑NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis O Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNe
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Eallo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
Slo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B -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
01 -No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewertinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RjNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5�No
❑ NA
❑ NE
A°ddTtionalaCo m Atsaadlor DrawingsWOO
7-P 40ru tar-
1_7tw-czl�_93 e% �!-1
f arm 1ia.:5 T& mss
/
_-! Temrns r}`
Page 3 of 3 12128/04

Type of Visit tDompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r D Departure Time: r (] County: 0r Region:
Farm Name: LA e Owner Email:
Owner Name: 1, Y_ Phone:
Mailing Address:
Physical Address:
Facility Contact: _ r��l ,���_ Title: �-r Phone No:
Onsite Representative: _ . S� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =1, = Longitude: =0=6
°06 =
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poul#ry C*opacity Population
❑ Layer _
❑ Non -Layer
I
Dry Poultry II
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Im acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
n
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 ® No ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
E A€o
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

l
` O
Facility Number:— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes nNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [a No [:INA ❑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 IA5LNo ❑ 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 [3 Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EZNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑I Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)F='SGtA 15e-e,rx�-da
13. Soil type(s)�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 95No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-.Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ®, No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes [3No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 5g -No ❑ NA ❑ NE
Comments (reamer to question #) Explain airy YES.,ansRers and/or any'recominendateons or, any other comments
[ase drawings`of facility to better explain situations. (use additional pages as necessary);
� d
Reviewer/Inspector Name �� Phone: 971% ,c/.l
ReviewerAnspector Signature: Date: 9—a #7/D
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo [-INA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ed No ❑ NA EINE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes C3 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 stain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EgNo [INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 91 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZjNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2•No
❑ NA
❑ NE
Other Issues
a- CDr/ rr e v -D dell
�/
/t'� �d+92. �f /L
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
29 No
❑ NA
❑ NE
24. 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
ER 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
MNo
[:1 NA
[_1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
(8 No
❑ NA
- ❑ NE
33. Does facility require a follow-up visit by same agency?
ayes
f9 Nom-❑ NA
❑ NE
AdditranAComments.ad llor Drawtngs•
a- CDr/ rr e v -D dell
�/
/t'� �d+92. �f /L
Lar a�Gi✓� �'!' ("<�I 7�� �" � �f p
I d-ai�_ �
Y `z"r 4i,,, We /a5
"7.
Page 3 of 3 12128104

NC;d6"f Nn. 201000876
s �ed 2-16-201c
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I -ZG-/O
Arrival Time:
:SSD
Departure Time: �.'/O County:-57dI`4,A/ Region: �A9
Farm Name: Ca s-1
❑ Dairy Heifer
❑ Farrow to Wean
Owner Email:
❑ Dry Cow
❑ Farrow to Feeder
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1 =64 Longitude: [� ° = d =
is
Design Current
S�+in( Capacity pu�lati�on
❑ Wean to Finish
❑ Wean to feeder
Egg Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Design Current
Cattle Capacity Population
El DaiCow
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Yes
❑ Turkeys
Q NA
Other
❑ Other
❑I urkey Puults
❑
Number of Structures:
Other
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
El No
�,/
LINA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
Q 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)
[I Yes
No
��//
[3 NA
[:]NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
,❑_,
G<o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
G<o
[:1 NA
❑ NE
other than from a discharge?
12128/04
Continued

Facility Number: 92__5Z16Date of Inspection
.�'f J✓�v�...w G�.C��d h�,,,1c ��i �� . S�'c_c_. - r�
L� �=�u�lota .- �. �.,..... �.� t`� �r4r�7 ;' n-• �o e e ss o l�
1�-r� d ! v P
Ir
Waste Collection & Treatment14
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
No
❑ NA
EINE
a. If yes, is waste level into the structural freeboard?
es
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): A
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
El Yes
��
D o
❑ 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) . brea notify
DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
L"fNo
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L_<o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El3 Yes
�
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
ElLlr
Etbio
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElD Yes
o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETNNoo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
TIC L ­C3 G o..! .,,.� v �� :..� r �L !✓c_ ;, r ,•� � lG.-si r � v c r..c V
rLA u S �Gc f l W ✓ . le wC.L S O A/c- C_ N c��-1 t�.�. ✓ 1�-[y S 6 c �/
c �" ` � /Liv • G ;,J �s nr0 kRk Z. 17C,
vwc�✓ /cs� n/i — / �ZS = /
ReviewerAnspector Name Phone3304
Reviewer/Inspector Signature: Date: 2-0 4F0
12/28/04 Continued

Facility Number: g2 S�/{® Date of Inspection 1-26 iO
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes l ,_,
< ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
Other Issues
Cv ►-. �:, i.�c� _ h�r IN lC '-3 �' Cl s N.,,a< c' �Pd /)
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA-
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EA4 ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,LK�-0-o
L`_TNo� NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L'fNo L l NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes4'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I— llfo ❑ NA
❑ NE
Other Issues
Cv ►-. �:, i.�c� _ h�r IN lC '-3 �' Cl s N.,,a< c' �Pd /)
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R<01 ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EA4 ❑ 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
_
L{'i10 0 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
❑ YesI
TNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewertinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E3<o ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ET5o ❑ NA
❑ NE
Additional Comments and/or Drawings:
Cv ►-. �:, i.�c� _ h�r IN lC '-3 �' Cl s N.,,a< c' �Pd /)
12118104

Type of Visit 0<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Z&7 ' Arrival Time: . Qn Departure Time: % 3 a County: Region:
Farm Name: I 1 % Owner Email:
Owner Name: d✓ c �'Gy Phone:
Mailing Address:
Physical Address:
Facility Contact: Car- � f�,� � �'/ Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = = =g Longitude: = O 0 = u
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder Q
Design Current
Wet Poultry Capacity Popula#ion
JEJ Layer
❑ Non -La er I I
Design C•arrent
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Feeder to Finish
❑Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
El Pullets
❑ Beef Brood Co
10 No
❑ Turkeys
❑ NE
Other
❑ Other
❑ T rkey Poults
❑Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
e. 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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
[_1 NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection O—
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA C1 NE
Structure 6
Identifier:
7/i
Spillway?:
t`7 --r,,5 ��SSa��5�G1tZ-� t�r SCd-�- �/�1cc ,Surma �%Ia�rJ�r✓ �S
Designed Freeboard (in):
Reviewer/Inspector Name Jam" �ir<�C�_ Phone: �✓j A9 `i 33— 33v-0
r �—
Reviewer/InspectorSignature: Date: ll; l/Ti:��
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?ElNA
❑ Yes
0 No
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[3 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
.Yes
❑ 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
[:1 Yes
[�INo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[.No
❑ NA ❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r� pY�r rx,� 1Ce L
13. Soil type(s) p tt
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? -Yes 600o"—❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes P9 No ❑ NA ❑ NE
17. Does the facility tack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes JRNo ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
i s
Comments (referto'questton, Explain any YES answers and/or any�recommendahons or any�other comments.
Use drawtngs of facity�to.better explain situations. (use additional pagers as necessary).
7/i
t`7 --r,,5 ��SSa��5�G1tZ-� t�r SCd-�- �/�1cc ,Surma �%Ia�rJ�r✓ �S
Reviewer/Inspector Name Jam" �ir<�C�_ Phone: �✓j A9 `i 33— 33v-0
r �—
Reviewer/InspectorSignature: Date: ll; l/Ti:��
�" AIV 12/28/04 Continued

{ Facility Number: Bate of lnspection D`
Required Records _&_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 124 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
5.No
❑ NA-
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®.No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[&No
❑ NA
❑ NE
Cather Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZL 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
f �No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
KLNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
)4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�/
S i3 o—*`�
�-OGuar'`r�t.
12/28/04

Type of Visit iiomoliance Inspection 0 Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit; � Arrival Time: c� J Departure Time: c� County: Q+n 00— Region:
Farm Name: of7' / r � r i r Owner Email:
Owner Name: Gcc ✓' l rS/ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1_1�r Title: Phone No:
Onsite Representative: O�,c _ , , Integrator: v/
Certified Operator:. �r_c. Operator Certification Number: y 3/
Back-up Operator;
Back-up Certification Number:
Location of Farm: Latitude: 1 --lo E:J ' E--]" Longitude: ED ° =1 I 0
Design Current
_i � °tea "`��'
Design t Cf6i nt
KNo
Design Current
SwineCa t `YPop lahon
P. t}
Wet Pvn�l _ p ulateou
fi7'ZQ ac�ty Pop.
Cattle
Capacity Population
t. „c.V ,.
to Finish
❑ La er
❑ Dai Cow
❑ Yes
to Feeder
❑Non -La er
❑ Dai Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
r to Finish
r -
❑ Dai Heifer
❑ NE
to Wean
#- v
Dry Poul n
❑ D Cow
w to Feeder
` " ` -"r3"
❑Non -Dairy
❑ No
to Finish
FOBoaTs
❑ NE
Beef Stocker
❑ Yes
4 No
❑ NA
Feeder
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Pullets❑Beef
❑ Beef Brood Co❑
❑ NE
other than from a discharge?
Turke s
'Turke Poults
❑ Other
Number of Structures:17
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
52 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
11/18104
Continued

r
I
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes M 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 EINE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
W No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require ❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
25No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
X 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 differ from those designated in the CAWMP? ❑ Yes
2jNO
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? Ryes
❑ No
[:1 NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ 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
0JNo
❑ NA ❑ NE
�� r z' ri �/k�'Y►� �T'�/r�T B�� ��` �� 'St r 8u
Reviewer/Inspector Namevig- __ Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 1.2128/04 Continued

I
Facility Number:— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
DINo
❑ 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
M 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
[S& No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B 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
.0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Division of Water Quality ,s
Facility Number ,, 0 Division of Soil and 'Vater Conservation /�',/y"07
O Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % _ � Arrival Time: * r9 Departure Time: �% aP County:
Farm Name: Ca I ? r Ad y of wry _ Owner Email:
Owner Name: 4 i r L � j ��,i Phone!
Mailing Address:
Physical Address:
Facility Contact: C!!/z _ i �� Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Region•?=
Latitude: a =� F-140 Longitude: =o =l =U
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
Wean to Feeder 4 ov (p D ❑Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures: 1E
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 JZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
0 N
❑Yes
0 N
❑ Yes
JO No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
12/28/04 Continued

.;l
Facility Number. Date of Inspection
1�
lnG j
AL
Waste Collection & Treatment
Reviewer/Inspector Name �..�._ Phone: /Gr 3�-330
Reviewer/Inspector Signature: Date: //— 9";'._AD a'7
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5Q 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?:
Desi6med Freeboard (in):
Observed Freeboard (in):
5. Arc 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 ors -site which are not properly addressed and/or managed
❑ Yes
10 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?
14 Yes
❑ No
❑ NA
❑ NF
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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'.? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10°/a or 10 lbs ❑ Total Phosphor -us ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DDrifl ❑ Application Outside of Area
12. Crop type(s) �i!'�Ct1 Y / / /N u Z927 &(, ; �
13. Soil type(s) gas Z�'a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? W 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'?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ No ❑ NA ❑ NE
[R No ❑ NA ❑ NE
2 No ❑ NA ❑ NE
(A No ❑ NA ❑ NE
Comments (refer to question i#): 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�
lnG j
AL
Reviewer/Inspector Name �..�._ Phone: /Gr 3�-330
Reviewer/Inspector Signature: Date: //— 9";'._AD a'7
IV 12/28/04 Continued

Q
t
Facili. tyNumber.A5X Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ElNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
2 1. 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑Yes
®No
El NA
El NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
P9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes El No ❑ NA ❑ NE
12/28104

(916ivisiowof Water Quality
Facility Number O Division of Soil and Water Conservation '�:
* 0 Other Agency.:'.
Type of Visit 0:b6mpliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit b Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 0-6 jq Arrival Time: 0 J Departure Time: County: Region:
Farm Name: z�t ✓ yN UI +'5 r _ Owner Email:/}
Owner Name: C ��- h i L� Phone: 9 '�4ZI 7d
5-c,-
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �'� Integrator:
Certified Operator: 5-- Operator Certification Number: Zeal
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0=I = U Longitude: =0=1 E:]W
Discharges & Stream Impacts
❑ Layers
❑ Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
1. Is any discharge observed from any part of the operation?
Design Currenf�
Design Current '
❑ NA
Design Current
Swine
Capacity Papulation x Wet Poultry
Capacity Population.
.Cattle
Capacity PxopuIlaatiiio�n}.
❑ Wean to Finish❑ Layer
❑ Dai Cow
MNo
Wean to Feeder
D D _Y ❑ Non -La er
t
❑ Daia Calf
[,No
❑ Feeder to Finish
❑ NE
J
❑Dairy Heifer
❑ Farrow to Wean
Dry Poultry
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Dry Cow
allo
❑ Farrow to Feeder
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Dairy
allo
❑ Farrow to Finish
❑ NE
`
❑ Beef Stocker
ZI No
❑ Gilts
❑ NE
other than from a discharge?
❑ Beef Feeder
❑ Boars
Page 1 of .3
❑Beef Brood Co
f
i - -
_...___ .
Other,.
❑ Other
Number of Structures:
_
Discharges & Stream Impacts
❑ Layers
❑ Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
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
MNo
❑ NA
EINE
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
allo
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ZI No
❑ NA
❑ NE
other than from a discharge?
Page 1 of .3
12/28/04
Continued

Facility Number., —
Waste Collection & Treatment
Date of Inspection O ^ 1p Ia
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5No
a. If yes, is waste level into the structural freeboard? ❑ Yes A� No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in): ,;2:7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z 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 [[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 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [4 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 [q 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?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �► 8z-/ ; ��
Ir
13. Soil type(s)
-/6-d '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? MYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Lk No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes R No ❑ NA ❑ NE
❑ Yes &.No ❑ NA ❑ NE
Comments (refer to question'#f):'Explain any YES answers and/or ank..r - ommendations or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
- Date: /13 DtP
12/28/04 Continued

Facility Number: — Date of Inspection ' 0
' Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ 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 Ll Design El Maps [:1 Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [4 No [:INA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Wo ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EQ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[--]Yes
J( No
[JNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
59 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
allo
❑ 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
54 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Addiiiorial Gomiimnts'and/or Drawings:
a
Page 3 of 3 12/28/04

f
Type of Visit 49 Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1/- - O j Arrival Time: '$O Departure Time: County:Sp'+�ea Region: �p
Farm Name: C.11 Ir Owner Email:
Owner Name: ev
Phone: ___510--5-32-29,273
Mailing Address: 0172'T�, � I�,'��c.,��, /VC �8yyy
Physical Address:
Facility Contact: Title:
Onsite Representative: CQ r / 09,h, 714
Certified Operator: C a,-/Rde
Back-up Operator:
Location of Farm:
I Swine.
Phone No:
Integrator:„s
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
❑ f = Longitude: =11=1 ❑u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
[]mean to Feeder j4zC,0 1 5 UD c, 10 Non -Layer
❑ Feeder to Finish-
❑ Farrow to Wean i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
i
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current" "
Cattle CapacityPopulation
❑
Dairy Cow
❑ Daia Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the Siate (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 21�O ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
[:INA
❑NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
El -No
❑ NA
❑ NE
12/28/04 Continued

9 ,
Facility Number: -,Sy(, Date of Inspection �% D
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: -T
Spillway?: o
Designed Freeboard (in): 9 y "'
Observed Freeboard (in): _-2 '1 "
❑ Yes aN' o ❑ 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?
El Yes ['ANO [_1 NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [a< [INA ❑ 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 allo ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ Yes
2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
BNo
❑ NA ❑ NE
maintenance/improvement?
IL
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ON' o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
I)2 Vis �.ti, F- Jys 3-s- So
12.
Crop type(s) _ :�4 &P Fm to QjS snh a// 61r'or,�
-
13.
Soil type(s) /Q
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑filo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA 2 NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[-]
Yes
❑ No
❑ NA 2'NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA 2NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[ o
❑ NA ❑ NE
ity to't etter eapt
CatiS]fa� �e�t� .'S o�orn9 �0 6e
re4or.3ed "Xis s'020-r.r so.,'.,'j,
Reviewer/Inspector Name Ir M.T. Phone: -
Reviewer/Inspector Signature: Date: L/ -o
12/28/04 Continued

Facility Number: Date of Inspection
Reoui_red Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 2<s [I Nom El NA ❑ NE
MP
20. Does the facility fail to have all components of the CAWreadily available? If yes, check E] Yes 1r No ❑ NA ❑ NE
the appropirate box. ❑ WtA1 ❑ Chvxk fists ❑ D!!i ❑DAaps ❑ OtW
21. Does record keeping need improvement? If yes, check the appro nate box below. ❑ Yes ❑'leo ❑ NA ❑ NE
/
❑ ttda�}ication ❑ oa Waste Ana ysis ❑clysis ❑ hers ❑ 4Eer4i€cation
❑rirg ❑ Id ❑ ❑ m ❑�dzathcr�edr
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 fait to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[;?No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
2 NE
❑ Yes
❑ No
❑ NA
DNI?
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
BINE
❑ Yes D'&o ❑ NA ❑ NE
❑ Yes 2f4o ❑ NA ❑ NE
❑ Yes [�Io ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
A�diti�s.�t
onaljlCommeaaad/orbrawingsr
I I ��fS�lpc�pl L.i,II rnGr( Q GPrry ST` L�E �G/r�+,1 �n� �Gri� f, Y G LD✓erlvye'
plea c %ars
S CO� i/1 OCQtrt %Corr61
12/18104

Facility Number Date of Visit: I Time:
rO Not Operational Q Below Threshold
19 Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above
'{{—••----........_...._._ • .... Threshold: -------
Farm Name: ..... _.. ------• County ......
\�'"` f� �Q!^_......_.....
Owner Name: Gar __. ..� 4 4Q Phone No: (710
Mailing Address:..... 9 7t!o........Tw............
Facility Contact: .. i.,r�it C.A L A e - Title. Phone No:
Onsite Representative: .... .�............._........................................_..Integrator:.............. I — u,Z • __ _
Certified Operator:,_•,,,,,, ctx r....... Operator --_ Operator Certification Number: --
Location of Farm:
�I
i
($Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �"
Disc es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gm/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P&No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes D;No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................. ......
Freeboard (inches):i
12112103 Continued

Facility Number: $Z — 5%
Date of Inspections/i�el
5. Are there any immediate threats to the integrity of any of the structures observed? (ief trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Apvlication
10. Are there any buffers that need maintenancelimprovement?
❑ Yes 11 No
❑ Yes ANo
[:]Yes RNo
❑ Yes PVO
❑ Yes RNo
❑ Yes MNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes RNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ;elsp" e i genu& Umar C Pas 4rur-L Sws a �� a rein ►� a Ie-rrSe-e& _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0 No
b) Does the facility need a wettable acre determination? ❑ Yes 0 No
c) This facility is pended for a wettable acre determination? ❑ Yes Wo
15. Does the receiving crop need improvement? ❑ Yes JqNo
16. is there a lack of adequate waste application equipment? ❑ Yes allo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [I Yes �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 &No
Air Quality representative immediately.
_Col mints {refer #o�4hcs6on #) Explant arty *YES answers and/v`r any>recommeudations or any, 0t6cr, oosanoti iii -T - a:
:Use dawtngs,.o# fae�ty to b explatsttaatsotts {tom attonal pages as neetssary} , geld p� Final Notes
� • plear� w+cw 5 �d� ��i�S o � Coax -
l7. �t r c� Ste- + T*� r � 5 P r� qq � � k] Q, c vv� � oCci : v. '�u�•-� tt-+� ��`- T+o >f
a_
Reviewer/Inspector Name v -r do J�k .. =�;x �,'
Reviewer/Inspector Signature: Date: �`' l(p 0
11112103 ` Conlinned

Faylity Number: 8L_ 47+{ Date of Inspection_ 0
suo mmertts and/or:Drawutgs- —� r -
.h.�.A�"�gx'.^£.....w:-.i5�:-+-•:�-
Z; . AAV. Q; lel ,no+- lnag a it*- So [ q,,,,a, �.rS i S ;or s %i etas ov. t4c.
Required Records & Documents
rArv­� S4" YtRt� 1D Q @.K GCx-t le" , 6 -it"
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
09 No
22. Does the ffapility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUF,'checklisW&sigw,-fna , etc.)
❑
1ZNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
IRYes
❑ No
❑ Waste Applicaticw--�❑ Freeboaar"❑ Waste Analyoel 14 Soil Sampling
311VoK : z 4 (ohs/oy r Z.}
24. Is facility not in comp ante with any applicable setback criteria in effect at the time of design?
❑ Yes
2Vo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
WNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
KNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
H No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[:1 Yes
%No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
]%No
31. If selected, did the facility fail to install and maintain rainbreakets on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfa*"'O Inspection After V Raiff
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.,
suo mmertts and/or:Drawutgs- —� r -
.h.�.A�"�gx'.^£.....w:-.i5�:-+-•:�-
Z; . AAV. Q; lel ,no+- lnag a it*- So [ q,,,,a, �.rS i S ;or s %i etas ov. t4c.
•
rArv­� S4" YtRt� 1D Q @.K GCx-t le" , 6 -it"
co►w p v -4-ef v�:J{+`tr.i ! +i �S P r� v �.,�� its vt� &
reGcrols .
12112103

f Site Requires Immediate Attention: _ AlCJ
Facility No. -.394
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: %G 91995
Time: /- = ui'
Farm Na
Mailing Address:- t I 7.5__/
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location:_ y',- - _69 r. s qzj f„ Qd,PC; :j o"_
Type of Operation: Swine / Poultry Cattle
Design Capacity: Number of Animals on Site: - )4r9� 5 ••� - -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon ha sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) r No Actual Freeboard: 2 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or �1v Was any erasion observed? Yes or Na
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: :o -"")o _'Vzt.c
Does the facility meet SCS minimum setback criteria? 200 Feet from Dw lin a or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes oNo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes or 10
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or IRIf Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or is
AdditionComments: 4,4 a X"14.1,11
r0
Inspec r Name
- '2�A //��
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NOU 17 ' 95 08:45 TO: 19104%%707
`i
P restage Farms, Inc.
Highway 421 South
P. U. Box 438
Clinton, NC 28328
[phone]
[phone] (Fax)
Comments:
FROM:PRESTAGE FARMS T-176 P.01
Date: �/117195
To: a,e A A XDa 0f7
Company: 6N R_ _ _ _
Fax #: 910, -"(0.0-76-7
From: 6. !'r_ "'4:- 7,2,-;
_..__. # of Pages Including Cover:—_--
Mad W
Initials of Transmitter:
_ _._WOv 17
--------`---ENV. MANAGEMENT— - -
FAYETTEVILLE REG. OFFiCq "

NOV 17 '95 08:45 TO: 19104860'707 FROM; PRESTAGE FARMS T-176 P-02
RZGIj,TRaT_^N FOPM FCR AXIMal MQL01 _ PEZA ON -z
Department of S ; r 'i �,- ,.nd -
nv_..,,n.^t���, :-iea�L_, and Natural resources
D_vision of Environmental Managemenr-
'nater Quality Section
I- ate animal waste management system for your feedlot cperaticn
is
designed tt serve more than or
equal to 100 head
of catzie,
75
hcrses, 250 serine, 1,000 sheep,
or 30,000 birds _ha=
are served
by
a liquid waste_ systam, t :en MRIs
fcrm must be filled
cut and :nailed
December 11, 1993 pursuant ,.L
VA ��A NCac 2H.020(c)
is order to
be
teemed permimmed by OEM. Please grin= clearly.
main " Ald ess .
County:
Owner (5) Name:
manager(s) Name:
Lessee Name:
F azm r ccation (Be as specific as possible: road names, directio4,
Design :aoacity of animal waste management system (Number and type
c_ cznfined an_ma1 (s))
,ve_age animal poeulation on the 'arm (dumber and type of animals)
Year Pr_ducticZ 3
egan:-ZAL ASCS T: act No.:��
"Yre of waste Management System used: I
Xcres Available `cr Land Apvlicatien of Waste:
�43?"C
Ow g L ,?�.�:L � DAT
DATO

NIU 17 '95 08:45 TO:19104860707
L r�
FROM:PRESTAGE FARMS T-176- P.03
Site Requires Immediate Attention: _ %"JG
Facility No. NIA
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: J t `S , 1995
Time: i .S•' S
Farm Name/Owner: K i 14-(-% L; N 4G.�
Mailing Address: t 1 R 7- i oT N -_ —
County: !3& M Ps e N
Integrator: I -t Phone: %O) 579.?-- -
On Site Representative: K, t-+ Nd Phone:19lr1)
Physical Ad dressJ Location:
Type of Operation: Swine ✓ Poultry � Cattle
Design Capacity:.76,�t / z& o6J Number of Animals on Site:
DEM Certification Number: ACE,___DEM Certification Number: ACNEW
Latitude: ° ' _," Longitude:-- ° -_I
Circle Yes or No
Does the Animal Waste Lagoon h v sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: _Z_Ft. _Inches
Was any seepage observed from the loon(s)? Yes o>t N Was any erosion observed? Yes oxj§�
Is adequate land available for spray? or No Is the cover crop adequate? (Soor No
Crop(s) being utilized: —
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? t or No
100 Feet from Wells? es r Na
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oft
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(�
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes 06� If Yes, Please Explain,
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec'fic acreage w� cover crop)? �r No
Additional Comments: e • i fe _ - 9'3
r
-- - i.c��ve
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: A/0
Facility No. N/A
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: J I'S , 1995
Time: 15--# 5 2*
Farm Name/Owner. Kc,+ L r' ►.r s �, l Kcr' n L %nr cf s�
Mailing Address: FZ�_ I ass Z 5'i -" /2o -ser Awl NC '
County: SGS SaN
Integrator: ar Phone: rWO-) 57`pZ - 577'/
On Site Representative: K. L i Nds„ _Phone: _/ 9/U) 53 2 - 'VO2 -0
Physical Address/Location:
S
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3&* Farro"j Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:"
Circle Yes or No
Does the Animal Waste Lagoon hayr, sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: f' _Ft.Inches
Was any seepage observed from the lagoon(s)? Yes of Was any erosion observed? Yes oi9
Is adequate land available for spray?or No Is the cover crop adequate? Qor No
e
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweilin s? e or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 0<0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(s)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o>olp If Yes, Please Explain.
Does the facility maintain adequate waste management recReir
s (volumes of manure, land applied,
spray irrigated on specific acreage wi cover crop)? No
Additional Comments: ReSis�er �-Q.3
/3,-,-K%3 R tv c 1s
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.