820594_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
II

Type of Visit:Co7-V
lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 14�dEfjj Arrival Time: ; 3o Departure Time: County:
Farm Name: oavttt y Aja SS s' Owner Email:
Owner Name: �pt�(tit (Z �S Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: .W ar r),C4 S Title: Phone:
Onsite Representative: t�tr Integrator:
Certified Operator: ` Certification Number: 3
Back-up Operator:
Location of Farm:
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 th t' +-A I th t rea h d t f th Stat 11 1)
E] Yes 61 -t -o [—]NA [:]NE
E] Yes
[—]No
❑"'SIA
[:]NE
❑ Yes
❑ No
C3'IIA
Design Current
en
�� Dtxgn
Uu
Currestt
I� r� Design Current
Swine
Capacity Pop.
Wet Poultry
mgt
.�Capa
�op.
Cattle Capacity Pop.
Wean to FinishFIa
er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
@nrrent
D Cow
Farrow to Feeder
D : P,oult .
@a aci
I?o .
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
'
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c What th t' +-A I th t rea h d t f th Stat 11 1)
E] Yes 61 -t -o [—]NA [:]NE
E] Yes
[—]No
❑"'SIA
[:]NE
❑ Yes
❑ No
C3'IIA
❑ NE
is a es ima a vo ume a c e wa ers o e e {ga ons}.
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes EaNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: jDate of Inspection:
WaAe Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E5 AA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
❑ Yes
ETIN
❑ NA
❑ NE
Observed Freeboard (in): 3 0
❑ Yes
["No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
io
❑ 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
to
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
0 -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
�]/ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1Vo ❑ 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 E5/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 utside of Approved Area
12. CropType(s): ``rr p G X c -e, --,. &v Ife ` �y-�
-1�� � -
13. Soil Type(s): fl"'o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ETIN
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
["No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[A-ilro'
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[B No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 -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
6"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
(a No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
Ea/No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facili !Number: - (5- `t Date of Inspection: � H
24, bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ea. o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E2 -K6- ❑ 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:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes []'1Vo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1.3 -No ❑ NA ❑ NE
Other Issues
2$. 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? Ifyes, 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
E/rt(/17
f��j7
C
Tonal
CA qc:r 3U- �— 60 (
❑ Yes [A,<o ❑ NA ❑ NE
❑ Yes [3lo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
[:]Yes No
❑ Yes ['�No
❑ Yes 6 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone -.V4 3 -3T3
Date: Xy `t41_
2/417015

ype of visit: k0ocom ante inspection U operation Review U structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:
County: �RcgionF_;Z�_01
Farm Name: J 5-- J Owner Email:
Owner Name: _1( Phone:
Mailing Address:
Physical Address:
Facility Contact: -Daow 0-'S -5 Title:
Onsite Representative: i
Certified Operator:
Back-up Operator:
Location of Farm:
{
Latitude:
Phone:
Integrator:
Certification Number: P
Certification Number:
Longitude:
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes. notify DWR)
2. is there evidence of 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 .2'IgA ❑ NE
❑ Yes ❑ No �NA ❑ NE
❑ Yes ❑ No
❑ Yes -fj No
❑ Yes ENo
Q NA
Design Current
❑ NA
Des" n cei t s *T
Desigrt Current
Swine
Capacity Pop_
1�'et Poultry
Capacrty r ,Pop.Cattle
C+'apaclty Pop.
Finish
La er
Dai Cow
Feeder
Non -Laver
e:
Dai Calf
Dairy Heifer
4 Finish
to Wean
`Design Current
D Cow
o Feeder
D , Pqult .
Ca act P,O
-Dairyto
pFarrow
Finish
La ers
�r. Beef Stoeker
Non -La ers
Beef Feeder
Pullets
BeefBiDod CDW
Turke s
Turke Poults
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes. notify DWR)
2. is there evidence of 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 .2'IgA ❑ NE
❑ Yes ❑ No �NA ❑ NE
❑ Yes ❑ No
❑ Yes -fj No
❑ Yes ENo
Q NA
❑ NE
❑ NA
❑ NE
(DNA
❑ N E
Page 1 of 3 21412015 Continued

Facili Number: - Sj IDateof Inspection: .
Waste Collection & Treatment
A. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes u 5o ❑ 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?:
0 Yes
Q No
❑ NA
❑ NE
Designed Freeboard (in):
Does the receiving crop and/or land application site need improvement?
❑ Yes
Ceo
❑ NA
Observed Freeboard (in):^
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
ETNo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EiJ-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
17.
Does the facility lack adequate acreage for land application?
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ETN' o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[Z 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?
E] Yes
do
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
eNo
❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[l"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 [3No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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 Winnd� Drift ❑ Application Outside of Approved Area
12. Crop Type(s): l✓8�� [7 l�
13. Soil Type(s): N 0
I4. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
Q No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Ceo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
ETNo
❑ NA
❑ NE
acres determination?
/No
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[a
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No
❑ NA
❑ NE
Re
aired Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
G!rNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
eNo
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo
o [:]NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: Date of Inspection:
❑ Yes
La<o
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P -11o'
❑ 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.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
2eNo
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
its o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
La<o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the faeiiity pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
2eNo
❑ 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
❑"' o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
t
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[5No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ga'F4o
❑ NA
❑ NE
Reviewer/Inspector Signature: [ �I�V{I\ .. Date:It -347
Page 3 of 3 21412015

{ �c d
d�3
NJ�o q-�g � a0 IG � toc z.,
Structure Evaluation Inspection
Facility Number: -- Date:f !►I ' - r
Time in: 1 Time out: , [�
Farm Name: r—)nLAtv X S i Farm 911 address:
Owner Name:
Facility Contact:
tc
Onsite Representative: [ 1 Integrator: —L0—Vts
1±2
Certified Operator: / Cert. Number
Is storage capacity less than adequate? Yes No _L,C
If yes is waste level into the structural freeboard? Yes No
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.):
----- Are there any immediate threats to tli� integrity of any of the structures
observed? Yes No v
Do any structures lack adequate markers as required by the permit? Yes — No e--'
Does any part of the waste management system need repair Yes No x_ --
Condition of field's
Condition of receiving crop Ca
Comments: OA�' W
I

P4 5r 0 �6 9D
Type of Visit: Q>Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency 0 Other 0 Denied Access
—4 Date of Visit: Arrival Time:�� Departure Time: `' i County: M Region:
Farm Name: �Q YFWq 9 S - 3 Owner Email:
Owner Name: b,�,,yzSS Phone:
Mailing Address:
Physical Address:
Facility Contact:Imo" ej rTitle: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
W
Latitude:
Integrator: ����
Certification Number:y
Certification Number:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Design Current
[3'9o-
Design
Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle
Gepacity Pop.
Wean to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Layer
❑ No
[:rNA
Da' Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Feeder
Non -La er
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Da Calf
0 No
Feeder to Finish
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
? No
Da' Heifer
❑ NE
Farrow to Wean
❑ Yes
0No
Design
Current
Cow
Farrow to Feeder
D , l;oult .
Ca aei
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Other
jurkeyPoults
ther
.-�,...
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[3'9o-
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[3*IqA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[:rNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
0 No
C' NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
? No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412014 Continued

Facility Number: - Date of lets ection;IV J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1� o ❑ NAA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q4 A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R"- ❑ 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 as immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E1 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q o
[] NA
❑ NE
maintenance or improvement?
❑ Yes No
❑ NA
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis
Waste Application
[] Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ENo
❑ NA
❑ NE
maintenance or improvement?
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Eff 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 0 Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): N 0
13. Soil Type(s),j
14. Do the receiving crops differ from those designated int e CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ffNo
[.] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
eNo
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have Certificate Coverage & Permit
❑ NE
the to the of readily available?
[:]Yes E? 1V
[DNA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, cheek
❑ 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 No
❑ NA
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis
[jWaste Transfers
[] Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes a""
[:3 NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes LJ No
❑ NA
❑ NE
Page 2 of 3 2,,14/2014 Continued

Facili Number:- Date of Inspection:
24• Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1B 90 [3NA ❑ 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 [Zfo ❑ NA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [&44"
.. &4 " [] NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes 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 CfNo ❑ 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 &N ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � ❑ NA El NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? C]Yes I `J No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes if No ❑ NA ❑ NE
Comments (refer to question #) Explarri_any YES answers and/or any additional recommendations or any other com,men ;
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: e LA
Phone:07Lta
Reviewer/Inspector Signature: ` Date: -NTLTJ
Page 3 of 3 21412014

jType of Visit: CrUon�liance Inspection U Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: Routine Q Complaint O Follow-up Q Referral Q Emergency Q Other Q Denied Access 11
Date of Visit: Arrival Timer Departure Time:
i
Farm Name: t s -131 Owner Email:
Owner Name: - de�llty �` Phone:
Mailing Address:
Physical Address:
Facility Contact: T [ l _ Title:
Onsite Representative: j t
Certified Operator:
Back-up Operator:
County: ' Region: PHD
Phone:
Integrator: f Es ...o
-N
Certification Number: ��� Q
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Eapacity Pop.
Wean to Finish
Wean to Feeder
Wet Ponitry
Non -La er
DesignEurrent
Capacity
PoP,.
Design Current
Cattle Capacity Pop.
airy Cow
Dairy Calf
Feeder to Finish 934Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P■o al
Layers
Ea sce
P,o ,
a' Heifer
IDry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
2. Is there evidence of a past discharge from any part of the operation?
F] Yes
Beef Feeder
Boars
Pullets
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
Beef Brood Cow
-
Other
Turkg s
Turkey Poults
of the State other than from a discharge?
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [r No [] NA NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes E] No Q NA Q NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Yes
[:] No
J_j NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
E] No
ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
F] Yes
E!f No
NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
E3 -No
NA
NE
of the State other than from a discharge?
Page l of 3 2/4/2814 Continued

[Fatility Number. - Date of Inspection: r?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No B -9A- ❑ NE
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trecs, 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 o ❑ 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
[ <o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ YesET<�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0Xo
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
0 Yes
�Io
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �e,enwA._ S60
13. Soil Type(s): N n
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E24o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
r] Yes
[D"No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3'*No
[] NA
❑ NE
R_ eguired Records & Documents
<
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
F] Yes
YNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ l20 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes a [] NA ❑ NE
Page 2 of 3 2/4/2014 Continued

F;c7Mi Number: - Date of Ins ection: to
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [EI -N -o— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EI IQo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M Wo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 -Ko— ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�
❑ 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
[:�%_o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
['Vu
❑ 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
io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
N
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
FN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #) Explain any YESfansr ers and/or any additiouaL recommendations or any other,eouimeno-,
Use drawings of facility to better e, ipiain situations(use additional oases as necessary).
f
C'W 1'-6 V"114 t 5(ds10 - �- ► y -0 -a.s
P 9- i'
Reviewer/Inspector Name: � OIL, Phone:
Reviewer/Inspector Signature: Date:/() () F A
Page 3 of 3 214/2014

Q I Ivts I t -N 9D
IType of Visit: �,Liance inspection Q Operation Review 0 Structure Evaluation O Technical Assistanceeason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time r. Departure Time: Countyc7
Farm Name: 1 )Q t & 0 "' V -I Owner Email:
—�
Owner Name: C(
Mailing Address:
Physical Address:
Phone:
Region: R
Facility Contact: 01&1 Title: �Vl Phone:
Onsite Representative: integrator: �Pt'G
6L:�:
Certified Operator: f ( Certification Number: �J 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
11111311 Design Current
_ -
�;;?,'.,_` T3 - !')esign
Current
Design Current
Serine Capacity Pop.
Wet Poultry'
Capacity
Pap.
Cattle Capacity Pon.
❑ NE
TI.
Wean to Finish
FTLayer
❑ Yes
0 No
Da' Cow
Wean to Feeder III
INon-Layer
❑ Yes
❑ No
Da Calf
Feeder to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
Da Heifer
Farrow to Wean
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
W -
Dess
Current
Dry Cow
Farrow to Feeder
D . P,oult';
Cacisv
Po
Non -Dai
Farrow to Finish
Layers
[] Yes
�fo
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ffNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
❑ Yes
0 No
MNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
AIA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
[] No
2�rNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
UD -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
�fo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection;
Waste Collection & Treatment
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ZLNo ❑ 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:
❑Other:
-
Spillway?:
21. Does record keeping need improvement? If yes, check the appropriate box below.
•��,�
E] Yes
5:pCo
Designed Freeboard (in):
❑ NE..%1 4'
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Observed Freeboard (in): `7
❑ Rainfall ❑Stocking [D Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections C:] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E) -t0— ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
r4No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
MZ io J ❑ 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
[4_>i-' ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�.Pi6 r ❑ 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~❑
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑,Wb ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C3,NV'" ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload p 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): ;3 ee . 0 U0- 5 e'6
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ NE
❑ Yes gg-1Vo 0 NA ❑ NE
❑Yes C2.W—❑NA 0 N
❑ Yes EP16' ❑ NA ❑ NE
[]Yes ®.leo ❑ NA ❑ NE
❑ Yes [D,410 ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
❑ NA
❑ NE
'vu.. • 20..Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
;'o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements
❑Other:
-
21. Does record keeping need improvement? If yes, check the appropriate box below.
•��,�
E] Yes
5:pCo
' ❑ NA
❑ NE..%1 4'
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code"'
❑ Rainfall ❑Stocking [D Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections C:] 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
r4No
❑ NA
❑ NE
Page 2 of 3 214/2011 Continued

Facility umber: 0- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:)Failure to develop a FOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond M Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
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?
8<0 ❑ NA ❑ NE
0�lo ❑NA ❑NE
❑ Yes
MXo
❑ NA
❑ NE
❑ Yes
[g.Wo
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
❑ Yes C.No ❑ NA ❑ NE
❑ Yes 0,9 D NA ❑ NE
❑Yes QKu 0 N ONE
❑ Yes
Cg,?qo
❑ NA
❑ NE
❑ Yes
I9 1VD
❑ NA
❑ NE
❑ Yes
[g' Ilio
❑ NA
❑ NE
Comments. (refer to question#)Explain any YES answers and/or any additional recommendations orany.other commenE
ts. �
Use drawings of facility to better explain situations (use additional pages as necessary).' f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pho�iD;
Date:
21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0111outine 0 Complaint 0 Follow-up 0 Referral 0 Emereenev 0 Other 0 Denied Access
Date of Visit: � Arrival Time:Departure Time: '�County�P_— Region:
Farm Name: Jr�3 Owner Email:
Owner Name: WaJ6 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 1_9L o p r— Phone:
Onsite Representative: �j1r.� Integrator:T 5 ,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number.
Certification Number:
Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Desi Current
gn
Desi gn Current
Design Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Swine
Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
a. Was the conveyance man-made?
Wean to Finish
❑ No
La er
Dairy Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Wean to Feeder
❑ No
Non -I a er
Dairy Calf
c. What is the estimated volume that reached waters of the State (gallons)?
eeder to Finish
�I3
-
Dairy Heifer
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Farrow to Wean
❑ No
Design hCa renf
Cow
2. Is there evidence of a past discharge from any part of the operation?
Farrow to Feeder
URI No
D . I;oult . Ca actPo
Non -Dai
3. Were there any observable adverse impacts or potential adverse impacts to the waters -
Farrow to Finish
Co No
La ers
Beef Stocker
Gilts
Non -La ers
I Beef Feeder
Boars
Pullets
TurkSys
Beef Brood Cow
Other
- I
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
0 Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
URI No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters -
❑ Yes
Co No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: 513
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
[3 NA ❑NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CK 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
CA No
❑ NA
❑ N E
waste management or closure plan?
0 No
[] NA ❑ NE
the appropriate box.
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
[X No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ 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
Callo
9. Does any part of the waste management system other than the waste structures require
❑ Yes
1Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
13 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): e r' In 04- 1
13. Soil Type(s): �,r¢
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® 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?
Required Records & Documents
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes � No ❑ NA [:]NE
19. Did the facility fail to have the Certifcate 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
0 No
[] NA ❑ NE
the appropriate box.
❑WUP El Checklists [—]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
CA 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
Callo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes C& No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,_Z No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ YesV�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
2$. 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 Z No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes � No E] 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
No
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ YesNo
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
�.No
❑ NA
❑ NE
Comments (refer to question #I): Explain any YES answers and/or any additional recommendations or any, ---other co"mmentsfT��;,r= Y
Use drawings of facility to better explain situations (use additional pages as necessary).
Ta ex
y
frur,. S ��.�v+-�• of Lr,-; �Y�.�; a� �-r j t �De� %7 eta `7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g,9/0--Y_-U—_3a Dc�'
Date;�d13
2/412011

Itype of visa: w t-ompuance inspection v uperatnon xevtew U btructure r.vatuanon U t ecnmcat Assistance I
Reason for Visit: Gr/Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit:
Arrival Time:
Departure Time:
County�,gyr
Farm Name: Q
An� 1Z (,1) %5 S cM-
)A Owner Email:
W lPout t -t -Y
Ca ac�ty 4Pa
Cattle
Owner Name:q�� K CSA'S S Phone:
Mailing Address:
Physical Address:
Region: Ff�
Facility Contact: k &5 Title: _ Q t, j\ F11; Phone:
Onsite Representative: & Amp_ Integrator: P9. Esq_t^
Certified Operator: 5LAt- f Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischar es and Stream Impact
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 M No ❑ NA ❑ NE
❑ Yes ❑ No [ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
i
Desn Current
N NA
Desi n Current
pi
Design Current
Swine
acg ¢
-,.a Pop ° Pity
W lPout t -t -Y
Ca ac�ty 4Pa
Cattle
❑ NA
❑ NE
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish-
_
Dairy Heifer
Farrow Wean
Design
Dry Cow
to
Current
Farrow to Feeder
Dry Poul ``' "
Ca " eci Pio .
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
IJFForthcr
r
Turkey Poults
Other
Dischar es and Stream Impact
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 M No ❑ NA ❑ NE
❑ Yes ❑ No [ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
❑ No
N NA
© NE
❑ Yes
E] No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
Page I of 3 2/412011 Continued
11

i
z
❑ Yes
No
❑ NA
❑ NE
IFacility Number: - 5°i LA Date of Inspection: Ca
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:Z
Spillway?:
Designed Freeboard (in): 1g!
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a] 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
]o No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
g] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement`?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > l0% 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): CRMUN1 f aUE0_5FIF
13_ Soil Type(s): !i)v A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [0 No ❑ NA ❑ NE
15. Does the receiving; crop and/or land application site need improvement'? ❑ Yes [K] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes © No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes[OW]
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.
OWUP ❑Checklists ❑ Design a Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes 50 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

- 4
lFaciRty Number: - q 4 Bate of Inspection:
oL
[] No
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
® No
[] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Yes
® No
❑ Non-compliant sludge Ievels in any lagoon
permit? (i.e., discharge, freeboard problems, over -application)
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
No
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® 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
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond [] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[-]Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
No
❑ NA ❑ NE
Comments (refer to uestron` Explain any, YES answers and/or any additional recommendations or,any atheom6e-iffiAMANIMA
Use drawinEs of faculty t0:bei 'Vel
tier. explaln;situatians (use additional pales as necessary).
Reviewer/Inspector Name:
Reviewerhnspector Signature:
Page 3 of 3
Phone: Ql() - 30&-L W1
Date: aaulaoo
214/2011

t
Type of Visit: E)r-Compliance inspection U Operation Review O Structure Evaluation Q 'Technical Assistance
Reason for Visit: QrfCoutine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: —1% Arrival Time:!! ; C) Departure Time: [2= County-__��-� Region: �
Farm Name:,i cts rQf/J'l Owner Email: -�
Owner Name: :7-),Xej C y f� � s s Phone:
Mailing Address:
Physical Address:
Facility Contact: �a�,��r y �czSS Title:Phone:
Onsite Representative: �_ Integrator:
Certified Operator: Ste_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swineowt.bapacify Pop.
Wet Poultry
Capacity 1'op.-:, .:.
Cattle Capacity Pop.
Wean to Finisha
er
Dai Cow
Wean to Feeder1JUINon-LayeT
Dairy Calf
Feeder to Finish 71,9
=;a'a
Dairy Heifer
= Farrow to Wean
Design ' -urr ent
Dry Cow
Farrow to Feeder
D . � P,Tru- lfry
Po ,. , ,:
Non-Dairy
Farrow to Finish
Layers
M'
�`�"
Beef Stocker
Non -La ers
Beef Feeder
rs
Pullets
Beef Brood Cow
kGilts
Turke s
oultser
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 ZI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/1011 Continued

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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [RNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes ®, 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 [2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes EQ 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 Q No
0 NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus p 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):-rnt{�®li����-�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [5 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 ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑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 M No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes INo [DNA ❑ NE
Page 2 of 3 2/4/2011 Continued

[Facility Number: - `l Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E4 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 Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
[] Yes
® No
❑ NA
❑ NE
❑ Yes
P. No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes C. No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ® No
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes El No
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative? [:]Yes Ej No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 21 No
F] NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft. Explain any YES answers and/or any additional recommendations or. any outer comments:'
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:��r�3m
Date:
214/2011

Type of Visit (a.Cb-impliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: y /OI Arrival Time: ,� Q Departure Tune: .�j a County: Region: EK�
Farm Name: �aAsJy X -4S5 Fa AM_ �5 3� Owner Email:
Owner Name: 012 -MA K �a�sS Phone:
Mailing Address:
Physical Address:
Facility Contact: 9D12..idX ze44, Title: Phone No:
Onsite Representative: _5�-� Integrator: �rr3
Certified Operator: — jam"'' Operator Certification Number: 135
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: a e =' = Longitude: 0 0 =I
= u
Design Current
Design Current
Design Current
Serine Capaeit} Population
Wet Poultry Capacity Population
Cattle Capacity Population
r[Jj Wean to Finish _
❑ Layer
❑ Dairy Cow
❑ Dai Calf
Wean to Feeder
❑ Non -La er
Pa—Feeder to FinishI
97
Dry Pouttry
Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Farrow to Finish
❑Nan -La Non -Layers
❑ Pullets
El Beef Stocker
❑ Beef Feeder
❑Beef Brood Cowl
POTurGilts
Boars
❑ ke s
tither
❑ Other
❑ TurkeyPoults
❑ Other
Number of Strut:tures:
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
❑ No
[:]Yes
C,No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page l of 3 12/28/04 Continued

5
Facility Number:-- Date of Inspection
r
® No
❑ NA
❑ NE
❑ Yes
i Waste Collection & Treatment
❑ NA
❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® 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 reed maintenance or improvement?
❑ Yes
® No
❑ NA
❑ N E
8. Do any of the stuctures lack adequate markers as required by the permit?
0 Yes
[9 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
Ig.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNO
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ 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) , 3rrtM4
13_ Soil type(s) NO
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 R[ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [K No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
JD No
❑ NA
❑ NE
-• � ,:... _. K��. .tea �: --��1�
Comments 6' fer to question #):'Explain any YES answers and/or any recommendations or any, other coim_ ments� ;i.
Use'drawtngs.of facility to 1ietter.explain situations. (use additional-pagesiiiiV ecessary).
qr
Reviewer/Inspector Name
t�.
Phone:
/D --J �jj
ReviewerlInspector Signature:
.[nate:
Page 2 of 3 01 12128/04 Continued

Facility Number: Date of Inspection
�T I
f Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IN No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections' ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[5a No
❑ NA
EINE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27_
Did the facility fail to secure aphosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
Additional dmtnents ## r i rk4 gsw' g A:�
Page 3 of 3 12128104
Page 3 of 3 12128104

I
Type of Visit Q�,C6mpliance 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
Bate of visit: 1� Arrival Time: s (�% Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Qrr zo Title: A:if'+�/"J Phone No:
Onsite Representative: (ct.�� _ Integrator: ��`�.0017
sl�1!
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E]O EJ a Longitude: 0 ° = I 0 "
Design Current
SK�ne Capac1tpulation
❑ Wean to Finish
Design Current
Wet Poultry Capacity Pgpula#ion
10 Layer
Design Current
Cattle Capacity Pnpuiation
❑ Dairy Cow
❑ Wean to Feeder
I ❑ Non -Layer
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dairy Calf
Feeder to Finish
a. Was the conveyance man-made?
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Layers
ElNon-Dairy
❑ Farrow to Finish
❑ NE
El Beef Stacker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
LEI Boars
❑ Pullets
❑Beef Brood Cowl
❑ No
❑ Turkeys
❑ NE
Other
❑ TurkeyPoults
[Z No
❑ Other
❑Other
Number of Structun»s:El
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[Z No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

0
Facility Number: — Date of Inspection
qV
Waste Collection & 'Treatment
Reviewer/Inspector Signature: Date: 9
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(�3No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Stnucture 2 Structure ? Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): C2 z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2+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
54
❑ 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
MNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
No
[I NA
[I 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
5� 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 �K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windrow ❑ Evidencee of Wind Drift ❑ Application Outside of Area
12. Crop type's) `/ XU' a z ! V __66^3 z� �l
13. Soil type(s) A)41A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JZ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes 9 No ❑ NA [:INE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes O -No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
qV
Reviewer/inspector Name �� ( �v Phone:
Reviewer/Inspector Signature: Date: 9
72/281U4 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZ 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 ja No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA-
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[$No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
X 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
EANo
❑ 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
�RjNo
❑ 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
INNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

0
Type of Visit gWb`mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: BArrival Time: '� Departure Time: ; 3 q County: Region: �
Farm Name: _tonrinv ��.�>; �QJrlii� _4%6Lj Owner Email:
Owner Name.• ZQA S Phone:
Mailing Address:
Physical Address:
Facility Contact: 1�r?ffAf Na Title:
Onsite Representative: -�
Certified Operator: s-
Back -up Operator:
Phhoonnee No:
r
I ntegrator: �-T� • _ N
10-
Operator
Operator Certification Number -
Back-up Certification Number:
Vocation of Farm: Latitude: [� o = 4 = Longitude: =0=,
00, =
6.
llesign C►urrent
Swine C►apacity Population
V4etPoultry
Design` s. Current
Capfypulation
Design Current
Cattle Capacity Population
❑ NE
❑ Wean to Finish
❑ La er
iEz Cow
❑ Wean to Feeder
❑ Non -Layer
❑ No
❑Dai Calf
Feeder to Finish ZME b D
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
wYrrvs
Dairy Heifer
❑Farrow to Wean
Dry Poultry
c. What is the estimated volume that reached waters of the State (gallons)?
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ NA
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
C,NO
Beef Feeder
❑ Boars
❑ Pullets
❑ Yes
10
10 Beef Brood CA
❑ NA
❑ Turkevs
other than from a discharge?
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
12/28/04
—r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C,No
[:INA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
L.
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
C,NO
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: — Date of Inspection 'a
3
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:
❑ Yes [f No ❑ NA EINE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): (91
Observed Freeboard (in): 3/1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CA 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 [A 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? 5Q Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 04 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tR 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) A - ^
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5d No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
® No ❑ NA ❑ NE
(&No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations)or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary)
Reviewer/lnspector Name Phone: 9L_33r 33 0 0
Reviewer/inspector Signature: Date: G. %GZ pZDoe
Page 2 of - or 12/28/04 Continued

w
1� Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes IS No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
26.
Did the facilityfail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® 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
CNN.
❑ 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
[A 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
ENNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J9 No
❑ NA
❑ NE
Additional Cbmments and/or Drawings: .' c
Page 3 of 3 12128104

10'6ivision of Water Quality 151/191�'
Facility Number O Q Division of Soil and Water Conservation S/-1?-��7
O Other Agency
Type of VisitCommp�pllance
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 ❑ Denied Access
Date of Visit: — Arrival Time: ` 3 Departure Time: County: Region:.F_)_.z
Farm Name: Da an �e -6 FA# M 0�5 c.3 J Owner Email: - 2:/ C�6
Owner Name: __Dari rt N ZgLd, 6 Phoneme: T �� ` 7 `r�r��
Mailing Address: a wt -e— J . ;r -L 1 )i'L- c
Physical Address:
Facility Contact: )-,-)ail H y 5aS S Title:
Onsite Representative:
Certified Operator: , _ I !!i_1
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:.��3
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o E_1' ❑ « Longitude: 0 ° =' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discbartres & 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)
Design Current
Cattle Capacity Population
❑
DaiEy Cow
❑ Dairy Calf
❑ DaJEX Heifei
❑ D Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes BNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes P4qo ❑ NA ❑ NE
❑ Yes 9LNo ❑ NA EINE
12/28/04 Continued

Facility Number: V— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on-site which are not properly addressed and/or managed ❑ Yes Rf 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 9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes X No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fid No ❑ NA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z 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) It
14. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes H No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? [:]Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
10 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name r--yz- Gir w q 'V Phone:
Reviewer/Inspector Signature: Date: $ r /3� 0c-';tDC)
12128/44 Continued

Facility Number: — s Date of inspection r I
v Reguired 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 El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
5& No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) cerlification?
❑ Yes
®No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I[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
6d No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D4 No
❑ NA
❑ NE
Comments and/or Drawings:
12128/04

Type of Visit�C,ommpliance inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit d Routine Q Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:s�'D Arrival Time: r d Departure Time: �, �} fl County: Region: 0
Farm Name: ._D r1 Y1 y �o_s 4 rt1+'M X5--3 Owner Email:
Owner Name: — 0a n rt I-, r� r4 S,:5 Phone:
Mailing Address:
Physical Address:
Facility Contact: f - ZA m W a 5-g Title: Phone Na:
Onsite Representative: 5A'r- Integrator:
Certified Operator: Operator Certification Number: 1zF-3sd
Back-up Operator:
Back-up Certification Number:
Location of Farre: Latitude: =o ❑, 0" Longitude: ❑o [=` ='
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current Design Current
Design Current
Swine
C►apacity Popnlation Wet Poultry Capacity Population
C►attle C►apacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ ]`zon-La er
❑Dai Calf
Feeder to Finish 1
7,15-01 D
❑ Dairy Heifer
❑ Farrow to Wean
4 " '
D_ry Poultry _:
❑ Dry Cow
El Farrow to Feeder
Tow. i
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
on -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
.,, Turk
e a❑ e s
J14 No
Other'
l i
�.... ahs ❑ Turkey Points.
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Other
❑ Other
Number of Structures: ED
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q;�qo
❑ NA
EINE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
R No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
04 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
N No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
J14 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5allo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: S` Date of Inspection S fNt
_ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 14 No ❑ NA ❑ NE
a. if yes, is waste leve] into the structural freeboard? ❑ Yes ( No ❑ NA [__1 NE
Structure'] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?.-
Designed
pillway?:Designed Freeboard (in):
Observed Freeboard (in): (r
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 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 (9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ yes g No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes QkNo ❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes FV No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below_ ❑ Yes 4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10°/a 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) AA91nn '
f
14. Do the receiving crops differ from those designated in the CA WM P?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA
❑ NE
�gp� �a✓'r'9ti-
Reviewer/Inspector Name I C5 l r'I Phone:
Reviewer/InspectorSignature: Date: (0
12128/04 Continued

Facility Number: — Date of Inspection(v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JN 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 ❑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 V 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 � No [:1 NA El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IN No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
g 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
WNo
❑ NA
❑ NE
General Pen -nit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
4No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(9 No
❑ NA
❑ NE
Additional�Co� Jfiki" s�aa�d/ F D�awiugs f
_:� , �i
+ � •�;�` t r�
12/28/04

, . ® Division of Water Quality
Faelhty Number $a S90 Division of Soil and Rater Conservations
t, x -- ----- 0 Other Agency
., . -.,..
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit S Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % ryr��/w� Arrival Time: I I : 3 O Departure Time: County: _5_orr_..�tioN
Farm Name: _V_nr_�y aJS—Fa_r_ra .2 5- 3% Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Vey +� Qa sS
Certified Operator. 13 "S
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:Pr_GS_� L
Region: F79P
Operator Certification Number: 1933-0
Back-up Certification Number:
Latitude:
F_10
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I 1 ❑ Layer
❑ Wean to Feeder 1 10 Non -Layer
© Feederto Finish 73S0 1 7 S
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Discharges & 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?
« Longitude: ED e =
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf _
❑
Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
El
on-Dai -
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ETJ
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. Docs discharge bvpass 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
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
EINE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
EINE
❑ Yes
191 No
❑ NA
❑ NE
12/28/04 Continued

Facility Namber: p-,S'95i Date of Inspection
❑ Yes
Waste Collection & Treatment
❑ NA ❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes W 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?:
❑ yes
Designed Freeboard (in):
❑ NA ❑ NE
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes W 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 IN No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R 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)
4. Does any part of the waste management system other than the waste structures require
❑ yes
50 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
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of
Area
12. Crop types)r S A c
�1,c�
13. Soil type(s) NO No n
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
06 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
[A No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[q No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[)o No
❑ NA ❑ NE
Reviewer/ins ector Name � _�
Reviewer/inspector Q � � -.� r r .�-. Phone:
Reviewer/Inspector Signature: ,� Date: ljf Q S
12/28/04 Continued

Fdcility Number: Date of Inspection Ll�
Reuuired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [YJ No ❑ NA ❑ NE
the appropirate box_ ❑ WLJP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %) No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
[:1 Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
X] NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[M No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 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
g No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[R 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
[,I No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f i�+ No
❑ NA
❑ NE
Additiariai=Cgmmetztstandlor
Drawrngs
e
rr
12/28/04

e
Division of Water Quality
Facifi :Number �oZ 1 S y� f 0 Division of Soil and Water Conservation
— 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: s y G S Arrival Time: /O : ° Departure Time: County: _Semjagi Region:_
t
Farm Name: g IFe r � o .fes- /— .2 o Owner Email:
Owner Name: ocQe. A sSse. AAra %IIL� c_ ���� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: R S 1161244 Q ave X1U+
Certified Operator: pa r n v K. Q ass
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: 0
Phone No:
Integrator: PrCj+cn e
Operator Certification Number: /S'3S-0
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�j ❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any pan of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: =0=,
o=,
Design Current
Cattle Capacity Population
Number of Structures: . ©'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Docs discharge bypass thewaste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[91 No
❑ NA
❑ NE
12/28/04 Continued

1
Facility Number: --meq Date of Inspection % t�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: w +Q G r
Spillway?: 6w. 8 5 - 1(. 17 - 2 0
Designed Freeboard (in): 0702. [ 17/so S3
Observed Freeboard (in): �3ai `r' :2 4 o y 3" 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
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4.6 were answered yes, and tate situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
U No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes[
No
❑ NA [:1 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/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 Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) _ Ger W. , QQ ti, a � O s � w a ry L app
i e
13. Soil type(s) N e i31 Ne 14
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?
[g Yes
P No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑
Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[jj No
❑ NA ❑ NE
is -9 ke -ri e'u 6cAI-Lck. f 140L s -V ajoOAA
W G aak Lb r.. P +14-1 a. iQ lea ) t 'E 4 k t Co ta+-- e� oa a~ r e s
'r a Pro sir, o'F G �'► to -c dk q r a t"+L ,
ReviewerAns ector Name "' ,.'j Phone:
p d x a�� �
Reviewer/Inspector Signature: Date: L5 dl Z
12/28/04 Continued

Facility Number: p,� —rqy 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 El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. fA Yes ❑ No ❑ NA ❑ NE
❑ Waste Application BWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[✓Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [Ef Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other issues
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28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose ofdcad animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
u No
❑ NA
❑ NE
Addttiiioal Comments a6dl0r3Drawings
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12/28/04

H
Type of Visit * Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for visit • Routine Q Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access I
Facility Number Scl bate of Visit: Tune:
Q Not O erational Q Below Threshold
O''!�ermitted ©'fertified [3 ConditionaIly Certified 13 Registered Date Last Operated or Above Threshold: ..... ...__... W.
Farm Naive: .......... _... �5!1� ..a...�t! +!�f .. .�� ...... ..................... County: ._-tirap Q.! l.................. _F�,Lz ..._ .
Owner Name:....._. fi Ca l.t./�7.t c_.. P� �L��r�.....P..!l! ...147�IIS°_.. .,�.5 4[r ul.CS...... Phone No: ._.... `II g.,... .3..1...- �• � - ........................
Mailing Address:...P�._>Qx..__/I d �........._.? ^� :.!t.F!� - �NC - - _f S7'��— --- •._ �__. .._._ ........_
Facility Contact: .........Q,2 11....AA .%3._..... _. Title: .M . _..- ...... ._......... ........ Phone No:
Onsite Representative: , _ _._�.S.F . _ w..... _ —. _. Integrator. Pe 4
Certified Operator:.__......._...[ _C4Aa c . _ l� s. _._ r _._._.w . Operator Certification Number:
Location of Farm:
Egfwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 0« Longitude • 4 44
Disc es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [}N0
Discharge originated at: ❑ Lagoon ❑ Spray Field. ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If dischar=e is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _ --................... --- ---•-
Freeboard (inches): —3Q ",
❑ Yes
RNo
❑ Yes o
Cl Yes
ONO
❑ Yes
ETRO
❑ Yes
Structure 6
12112103 Continued

Facility Number: $ 2, --r
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
❑ Yes Q No
❑ Yes to
❑ Yes To
❑ Yes ❑W-
❑ Yes ❑'110
10. Are there any buffers that need maintenancetimprovement? ❑ Yes �o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑-iso
❑ Excessive Ponding ❑ P /AN ❑ Hydraulic Overload ❑ Frozen Ground E] Copper and/or Zinc
12. Crop type 6ermuda ! ky) . � -tea // Gra; n (Hal)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [3110
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ErNo
b) Does the facility need a wettable acre determination? ❑ Yes BNo
c) This facility is pended for a wettable acre determination? ❑ Yes [-10
15. Does the receiving crop need improvement? ❑ Yes Err- o
16. Is there a lack of adequate waste application equipment? ❑ Yes [}No
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 [gffo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes B No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air duality concern? If yes, contact a regional ❑ Yes 0 -No
Air Quality representative immediately.
�Cammiruts (reser to_queshan #) E7tplaiis auy YES answers andlor a ry,re�n�euda�oms ar sny ot>_ier com�ents.� .� �� Ntl
,Use drav�ngs of fac�ity to better explarn setoat�ans. Anse additeonai pages as necessary) veld Co Final Notes ; r
k � .�..._..� �. � �4 y�ZYi � L r-� .s`+a.�� `s.....+—,-�-'S..s.r(i. +x•t
er/Inspector Name
EReviewier/Inspector
Signature: Date: L j — / y - a
12112103 Continued

Facility Number. d 2 — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
tiTDES Pernnfiiteti Facilities
❑ Yes �io
❑ Yes ❑Wo
❑ Yes Elf4o
❑ Yes 9 a
❑ Yes ❑foo
❑ Yes QVo
❑ Yes [allo
❑ Yes ('No
❑ Yes EINo
30. Is the facility covered under a NPDES permit? (If no, skip questions 31-35) 9 -Yes ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M -Pio
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes El -No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes �lo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes pf4o
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑-Rio
❑ Stocking Form -'O Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Fornf'--
113No violations or deficiencies were noted during this visit_ You will receive no further correspondence about this visit.
Add ittOnal"Ommaats°an- d/or.Drawtngs
:�"%-.-"..,.'F='f•.... .i^{*'.a n':_:C.`. :t_'i r,_zll: !:,„T. r. -_..s .a_s:.._:e_ - _.__�... ."_;� '___-!'.-.. __,. �:'." ...x-:-- �a .� _t.s
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12/12/03

1
Facility Number
date of Visit:
$-Q3 Time:QLL
rO Not erational Below Threshold
Q Permitted ❑ Certified
© Conditionally Certified
❑ Registered
Date Last Operated or Above Threshold:
Farm Name: Ccf, 6
Farmso�
'S`.3
County: Sit ',As on
Owner Name• Ca rDllnAq ! er ri
* Adie
kyye4 TeS
Phone No: 9!9 - 9-3
Mailing Address: PO
Arawer IV9
_
56�f-A:Leld AIC_
Facility Contact: DA an
-y d es-rSTitle:
0992
nan e Phone No:
Onsite Representative: 1JAY1+7V
Integrator: An i -_ s7Aae-
Certified Operator: ha
rm
A Ss
Operator Certification Number:
_
Location of Farm:
14 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ~ " Longitude a
Desugn V': Gtirreat Design Cprrent Destgq Cnrrtnt
'Svftne.:- Ca ac tv Po ulation ._- _Poultrti Ca acitti -Fo utation Cattle
❑ Wean to Feeder ❑ Laver r ❑ Da' _
Feeder to Finish 1 1 T3 1 _ ❑ Non -Layer ©Nou-Dairy
❑ Farrow to Wean
El❑Other Farrow to Feeder =- -74
❑ �t Farrow to Finish ^_ -
Total DestgCapactri
❑ Gilts
❑ Boars ~: T66 SSLW
_Namber'of Lngcwns _. ,:
AD Subsurface Drains Present JE3 Lagoon Area 10 Spray Field Area i
HoEdrng Ponds/ Solid --T' - ❑ No Li uid Waste Mana emeut System f
Discharges S Stream ]pacts
1. 1s any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsmed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notifv D'%VQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
N ante Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
rt
Freeboard (inches):
05/03101
❑ Yes &I No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
Structure 6
Continued

1
Facitit�- Number: -- ntfN Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion. ❑ Yes ® No
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 ❑ Yes No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste ApRlicakion
10. Are there any buffers that need maintenance/improvement? ❑ Yes R1 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
I2. Crop type C= S- f -
-T
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes [4 No
15. Does tate receiving crop need improvement? ❑ Yes W No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
EM No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
g] No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
NJ No
22_
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑Yes
� No
(ie/discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
10 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
EM No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
IIQ No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.