820607_INSPECTIONS_20171231

�.A�
NORTH UAROLINA
Department of Environmental Qual

l 7 " Type of Visit: UConce Inspection U Operation Review U Structure Evaluation U Technical Assistance
Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date or visit: Arrival Time: 4 Departure Time: County: !?J 04 Region:
Farm Name: ct'4At ( J Owner Email:
Owner Name: ted Phone:
Mailing Address:
Physical Address:
Facility Contact: q eev q �QLS.� Title: Phone:
Onsite Representative: Integrator: pix --1
L 35LCertified Operator: Certification Number: _
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes ❑ No Q NA ❑ NE
b. Did the discharge reach waters of the State? (Ifyes, notify DWR)
❑ Yes [] No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
CSpacity
Pop.
Cattle Capacity Pop.
Wean tco Finish
❑ NE
of the State other than from a discharge?
La er
airy Cow
Wean to Feeder
Non -Layer
airy Calf
Feeder to Finish
! U v
Dai Heifer
Farrow to Wean
Design
Came©t.„
D Cow
Farrow to Feeder
D . l;oult ,
Ca aci
Pio
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
Turkey Poults
Other
Other'
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes ❑ No Q NA ❑ NE
b. Did the discharge reach waters of the State? (Ifyes, notify DWR)
❑ Yes [] No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
[3"NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes rl"Noo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

FaciUty Number: , p Date of Inspection: r :J
❑ Yes
Q'No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[ENo
❑ NA
❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-1To_­❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
D'tqA__
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Spillway?:
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EB ->q ­o_
❑ NA
[:].NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0-N°
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
D<
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 -No-
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [r] -No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [l] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Ej 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): 1�5E" t"if it S ��_� 17 t/ 9-U7�
13. Soil Type(s): �d rrs--tq
14. Do the receiving crops differ from those designated in the CA W M P? ❑ Yes [3'lq'o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ED, X10 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes ❑moo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes E3"No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q'No
❑ 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 ❑ I -ease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[;3'1g10
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[l] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faci4ty Number: - L! Date of Inspection: r9 t j.rc..
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes [3 -RC ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [_]'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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/]nspector Name:
Reviewer/Inspector Sigmature:
Page 3 of 3
❑ Yes [+iqo ❑ NA [] NE
❑ Yes [D'To ❑ N A {] NE
❑ Yes 0156 ❑ NA ❑ NE
❑ Yes [alo ❑ NA ❑ NE
❑ Yes E]"ko ❑ NA ❑ NE
❑ Yes 0'1'q -o ❑ NA ❑ NE
❑ Yes
to
❑ NA
❑ NE
[] Yes
T No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Phone:
Date: -�•M�
21412015

1 ype of v isit: t,7 t.omptiance inspection V operation meview U structure Evaluation U I eennical Assistance
Reason for Visit: COIoutine O Complaint Q Follow-up 0 Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time:Departure Time County:/4 K(
Farm Name: 'S 1 Owner Email: T�
Owner Name: Q " g&.r5 Phone:
Mailing Address:
Region: tp
Physical Address: �(
Facility Contact: r \ C S Title: Phone:
Onsite Representative: Integrator:
Certified Operator: ` Certification Number: 3 ��
Back-up Operator:
Certification Number:
Location of Harm: Latitude: Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry '
'._:.Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
❑ No
P'I�A
Dai Cow
Wean to Feeder
Non -Ira er
❑ No
[J NA
Dai Calf
Feeder to Finish
Dai � Heifer
Farrow to Wean
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
_
Design
Current
Cow
Farrow to Feeder
Dr. l;oultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
[] Yes
E�No
Beef Stocker
Gilts
of the State other than from a discharge?
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
F
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
to
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
P'I�A
❑ NE
b. Did the discharge reach waters of the State'? (If yes. notify DWR)
❑ Yes
❑ No
[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
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
E�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: Dn IDate of Inspection: 4
maintenance or improvement.0
[!I<o
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
heavy less
❑ NA
❑ NE
❑ Yes
0"No
4. Is storage capacity (structural plus storm storage plus rainfall) than adequate?
❑ Yes
[IrN-o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Rainfall ❑ Stocking. ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
Identifier:
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes['
❑ NA
❑ NE
Spillway?:
❑ Yes No
❑ NA
❑ NE
Designed Freeboard (in);
Observed Freeboard (in): g-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
fff"N o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[!![ ro
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ef"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
]o
❑ NA
❑ NE
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2:n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
pp/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
l2, Crop Type(s): CB
t3. Soil Type(s):
D �a
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?
0 Yes
[!I<o
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
0"No
❑ NA
❑ NE
❑ Yes ❑'No ❑ NA E] NE
[:]Yes [No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E]"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes Ef'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 eNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking. ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes['
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

r r
Facility Number:-IDate of Inspection: acc
❑ Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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
[30<No
❑ NA ❑ NE
the appropriate box(cs) below.
❑ Yes [Z"No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Yes G?(IN❑ NA ❑ NE
[] Non-compliant sludge levels in any lagoon
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes [`J No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
List structure(s) and date of first survey indicating non-compliance:
Comments (refer.to,question;' blam!aany+YES answers and/or any additiona&recommendations
Use drawings facility to�better�ezplatn�s�tustions � r
or any other cots bentk
fi 4 Vp
oi' .(use additional pages as necessary,).
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
L�FNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ON.
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �o ❑ 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 ETONo ❑ 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 RJ/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 [Z"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 G?(IN❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes [`J No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [%f No ❑ NA ❑ NE
Comments (refer.to,question;' blam!aany+YES answers and/or any additiona&recommendations
Use drawings facility to�better�ezplatn�s�tustions � r
or any other cots bentk
fi 4 Vp
oi' .(use additional pages as necessary,).
cAL
Reviewer/Inspector Name: Q k
Reviewer/Inspector Signature:
Purge 3 of 3
C'Q( vb-30$4o,
Plfone:' _f JJ
Date:
21412015

MA
I ype of visit: %0,compfiance inspection V operation Review V structure Evaluation V f'echnical Assistance
Reason for Visit: : rGutine a Complaint O Follow-up Q Referral 0 Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Timer County:
Farm Name: �C'�%AG4-d r L _ '�f Owner Email:
Owner Name: L Jq'( S Phone:
Mailing Address:
Physical Address:
Facility Contact: L/CN�L>%-1;1,
Title:
Onsite Representative: f
Certified Operator:yl
Back-up Operator:
Location of Farm:
Latitude:
Region.
�
Phone:
Integrator:
Certification Number:��(
Certification Number:
Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
can to Finish
❑ Yes
I JI-ayer
EIIIII
❑ NE
Dairy Cow
Wean to Feeder
I
jNon-Laer
I
c. What is the estimated volume that reached waters of the State (gaIlons)?
Dairy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
Dairy Heifer
Farrow to Wean
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Design
Crirrent
Dry Cow
Farrow to Feeder
3. Were there any observable adverse impacts or potential adverse impacts to the waters
D . P,ou1
Ca aci
Po
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
In,
Turkey Poults
J[j0ther
L Other
Discharges and Stream ImDaets
1. is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EIIIII
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
Fj'NA
❑ NE
c. What is the estimated volume that reached waters of the State (gaIlons)?
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
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facili Number: - Date of Inspection: 9j 'J4 -t IU
Wastg Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes [R 0� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes © ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
E34o
[] NA
Observed Freeboard (in):
[:]Yes
[ffNo
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes U2 -N-5 ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
[] NA
❑ NE
6. Are there structures an -site which are not properly addressed and/or managed through a
❑ Yes C_ o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
a NA
❑ Yesr-N-o
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes E;Hq ' [DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes [ to ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 2r<o [] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window [] Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s): tS 46
13. Soil Type(s): 'Q e2- J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O No [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FeNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes 2 -No ❑ NA ❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
18_ Is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[--]Yes
E34o
[] NA
❑ NE
[:]Yes
[ffNo
❑ NA
❑ NE
[:]Yes
BNo
[] NA
❑ NE
❑ Yes
ETNo
[] NA
❑ NE
[:]Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes E5<o DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

i
[Facility Number: - ©ate of lns ectian:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes go E] NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo F] NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 tilt drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond [] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes Lei o ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes E]I o ❑ NA ❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
LfJ N
[DNA
❑ NE
❑ Yes
[3Yes
VNo
E]NA
❑ NA
❑ NE
❑ NE
Comments (refer to question #) -Explain. any YES answers and/or any additional recommendations or any other caritments:
Use drawings of facility to better.eapla_in situations (use: additionalpages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
,19 -_ �3 X33
Phone:
Date: �V `
21420!4

h
(Type of Visit: C3 -,Compliance Inspection V Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Q utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: VO 151 Arrival Time: Departure Time: O County:
Farm Name:_ y Owner Email:
Owner Name: �� Phone:
Mailing Address:
Region F
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: t Integrator: c aa
Certified Operator: Certification Number: "i U '01j
Back-up Operator: Certification Number;
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pap.
Design Current
Cattle Capaeity Pop.
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . P,onl
Design
Ca aci
Current
P,o
Dai Heifer
Cow
Non -Dairy
Farrow to Finish
Layers
❑ No
FT-N—A
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Beef Brood Cow
Otherm
Turke s
Turkey Poults
E] NE
2. Is there evidence of a past discharge from any part of the operation?
E] Yes
Other Other
Discharges and Stream Impacts
1, is any discharge observed from any part of the operation?
[:]Yes
[R'Ko—
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
0 No
[3'9A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
FT-N—A
❑ 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
[D No
A
E] NE
2. Is there evidence of a past discharge from any part of the operation?
E] 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 1/412014 Continued

Facility Number: jDate of inspection: ty -f—I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]'Ko' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q -KA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes E21<o
❑ NA
❑ NE
maintenance or improvement?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a 1V °
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Excessive Ponding (] Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E'No
❑ NA
❑ NE
waste management or closure plan?
13. Soil Type(): C
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?
❑ Yes
MNom
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
[—]Yes
DIL
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E21<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes 0 ""'
❑ 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): eov4UL '56-0
13. Soil Type(): C
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Ea<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 1g"'
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0'
❑ 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?
Reouired Records & Documents
❑ Yes E54o ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑10 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ 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. 0 Yes [31Z ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ RainfaIl ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Faftfity Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [3<o—
i<u [] NA [::] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes DIG [D.M� ONE
the appropriate box(es) below.
[] Failure to complete annual sludge survey Failure to develop a POA for sludge Ievels
[] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? 0 Yes No 0 NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes Na 0 NA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field [] Lagoon/Storage Pond ❑ Other:
0 Yes l.ld'No [] NA ❑ NE
❑ Yes []'o [] NA ❑ NE
❑ Yes E244o [:] NA ONE
Yes L 24o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�In [3 NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[::] Yes
[T No 0 NA
ONE
N
34. Does the facility require a follow-up visit by the same agency?
Yes
[/ [:] NA
[:] NE
Comments (refer toquestion,#) �Expiarn°anyYES: answers and/or any additional: recommendations or any other comments.'W
Use drawings of facility to better eiplauisithi?!tions (use additional pages as necessary)•
°=
Cr'�I;-b 1*4tv-9 V,
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3of3
I in
Phone: 1,
.S `
Date: it - f}
2/4/2014

(Type of Visit: U 701"
ance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit:tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: C Departure Time: 1 777 County: �4 w
Farm Name Q L 0 f—a r"--- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C ow& v Title:
Onsite Representative: k
Certified Operator:
Back-up Operator:
Location of Farm:
if
Latitude:
Region: tn
Phone:
Integrator: Le
Certification Number: % 3 L�
Certification Number:
Longitude:
Design Current`"'
`; Destgn ;,Current
Design Current
Swine Ca aci Po
P ty P•
ri
Wet PoultryY„n ; Capac1ty Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
[:]Yes
airy Heifer
Farrow to WeanOR.Dest
n ,Current
Cow
Farrow to Feeder
.I'oWtCa acs P,o
rN
Non -Dairy
Farrow to Finish
a ers
Beef Stocker
Gilts
on -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Other
Discharges and Stream Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[-]Yes B -5o ❑ NA ❑ NE
❑ Yes ❑ No E3 -NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
®-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
g3l�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[]�,W
[DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
To
[DNA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number: - Date of Ins cellon:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
E5'1V6 ❑ NA ❑ NE
1_W"'o ❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes s- lo' [DNA ❑ 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 Ea.NT— ❑ 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
Lg-Ko`
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q Ng,
❑ 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
CZP,' i
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z j k6"
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
PR<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of W'nd gnft ❑ Appl'ca11
Outside of Approved
Area
12. Crop Types}:1_A2to)e-,-�(X
13. Soil Type(s): E% 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U '"o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[B.No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F4q o
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
Io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[TNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0-9o-
❑ 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
[ffNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[?No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNo
❑ NA
❑ NE
Page 2 of 3
1/412011 Continued

FaCill Number: Date of Ins ection:
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 POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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 duality 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)
3l. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
®-?dor' ❑ NA Q NE
[�o [] NA ❑ NE
❑ Yes Ldl`o ❑ NA ❑ NE
[D Yes g V�o ~ ❑ NA [] NE
❑ Yes r ❑ NA [] NE
❑ Yes 2'7To [] NA ❑ NE
❑ Yes [?T<o [] NA ❑ NE
❑ Yes PN* ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWM.P? ❑ Yes Q-f4o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [911o' ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [g'<To ❑ NA ❑ NE
Comments (refer to question ff)Explain-any YES answers and/or any additional recommendations"or any -other catn11iteuts:°
Use drawings of faelit3 t:_aobetterexPlain;situtions ° use additional pages as necessa_ y
V LQ.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Ph`�!:� I i -Jj
Date: I Vd"y 1
Page 3 of 3 214/2011

(Type of Visit: (ZMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0HP(outine O Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ! ] County: ,,yr�r� Region: P)P-0
Farm Name: J, 01 V f( .S.s 6EeYN 2p,0;'
Owner Name: PQ,.rn
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: a Title: Phone:
Onsite Representative:5.� Integrator: �rt-ary�
.. _ y.
401
Certified Operator: y or— Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
IDr. Paul
Layers
Design
Ca aci
-
Current
1?0 .-
Dai Calf
Dai Heifer
D Cow
Non -Dai
Beef Stocker
Feeder to Finish fl
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
urkey Poults
Other ]gr
Otlter
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ "o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes 0No
❑ Yes R No
[]NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of inspection:
❑ Yes
KNo
❑ NA
❑ NE
Waste Collection & Treatment
Yes
0 No
❑ 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 l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Spillway?:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
D Yes
R No
Designed Freeboard (in). -' J
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�3No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
fR No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
[] Yes
5�jNo
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift /❑ Application Outside of Approved Area
12. Crop Type(s): / B ye'r.4 moi' 1rN II f / i�tl -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes rNo [DNA ❑ 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?
Reouired Records & Documents
❑ Yes RNo ❑ NA ❑ NE
[:]Yes JKNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ 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 ❑Checklists ❑ Design ❑ Maps 0 Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
R No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ 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?
D Yes
R No
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Eq -No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -Date of Ins ecdow
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List 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 JR No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ja No ❑ NA ❑ NE
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes tij.-No ❑ NA ❑ NE
[:]Yes Wo ❑ NA ❑ NE
❑ Yes
Ej�-No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other coiaments*_.
Use drawings of facility to better exalain situations fuse additional naaes as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 220
Date: T �- p /3,
2/4/2011

- Ubih�
W]
Type of Visit: (YCompliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: tr.,,i/,tt(autine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access 1!
Date of Visit:"t� Arrival Time: Departure Time: County:
Farm Name: -- �pt�n {. Q)pSS FAQr-al' oZy Owner Email:
Owner Name: K J�ASs Phone:
Mailing Address:
Physical Address:
Facility Contact: An nvgSs _ _ Title: �j L- n (Z Phone:
Onsite Representative:
" d?xuDesign
Gnrrent
Certified Operator:
{atm
Back-up Operator:
[ NA
Region: FRO
Integrator:
Certification Number: $3
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
" d?xuDesign
Gnrrent
Design Current
❑ Yes
❑ No
[ NA
❑ NE
SwineCapacity Pop.
Wet Paul* Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Daig Cow
Wean to Feeder
Non -La cr
Dairy Calf
Feeder to Finish A
Dairy Heifer
Farrow to Wean
_ Design
Current
Dry Cow
Farrow to Feeder
Dry Pn_ult Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
111111
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? (lf yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[] Yes [M 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 M NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 1M7f4J No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes a] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

t,
Facile Number: a - Date of Inspection: ti d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
[QNo ❑NA ❑NE
[D No ®NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A� a
Spillway?:
Designed Freeboard (in): lot
Observed Freeboard (in): 33:1.
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes JK] No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
®No
❑ NA
❑ NE
waste management or closure plan?
❑ 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[V No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of -Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
�ai, PW)
12. Crop Type(s): F_Q,muDC 1 0 �'j C 2 �-u> I [ r\_1 \IT-: I L)a VAVZ Anna i
13. Soil Type(s): Ng)A. Gey R _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA D 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
V] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ff] No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps E] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall E] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge'. ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
[]Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: - Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes a] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes © No ❑ NA [D NE
❑ Yes V] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
M No
Ldki
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
Reviewer/Inspector Signature: _ o fate: (p1aCo la 0;7t
Page 3 of 3 21412011

Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: patine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! p'v Departure Time: County: Region:
Farm Name:_ ]5 mj 5 _�drr*ti �` Owner Email:
Owner Name: �ct n� _ f �u S,S Phone:
Mailing Address:
Physical Address:
Facility Contact: 0 cc..�t+/ �'Q,�� —Title:�Phone:
Onsite Representative: Integrator: r
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [. No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No DNA EINE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E. No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued
Design
Current `� Design ` Current
DesNew!ign Current
Swine
Capaci
ICattle Capacity Pop.
ElwinWean
to Finish
JDairy Cow
Wean to Feeder
Non -La cr
IDairy Calf
Feeder to Finish
Farrow to Wean
`'s°Desrgn Current
D , iP._oult :Ca achy P,o .
113airy Heifer
Dry Cow
Non -Dai
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La crs
Beef Feeder
Boars
Pullets
Beef Brood Cow
.a Turke s
Qther
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [. No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No DNA EINE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E. No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: - p Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA
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?
(i.e., large trees, severe erosion, seepage, etc.)
❑WE
❑ WE
❑ Yes KNo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ WE
waste management or closure plan?
❑ Yes
allo
❑ NA
❑ WE
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
( No
❑ NA
❑ WE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NF
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
[:INA
❑ NE
maintenance or improvement?
[a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Waste Application
[, No
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ WE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [9 -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12- Crop Type(s): ter. UJ,2
13. Soil Type(s): Z97 "
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ WE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ® No ❑ NA ❑ WE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ WE
acres determination?
17. Does the facility lack adequate acreage for land application?
I& Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes 0 No ❑ NA ❑ WE
❑ Yes O'No ❑ NA ❑ WE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ WE
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
[—]Other,
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[N No
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield [:1120 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
[, No
❑ NA
❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: jDate of Inspection: 9­=
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [S No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance-
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? 1f yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes §q No ❑ NA ❑ NE
❑ Yes 'WNo
[:]Yes R No
❑ Yes FXLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to gnestron #) �EaPlam aay�YES answers and/or any additional,recommendations or any other comments:
Use drawings of facility to,better,explarn3situatrons'(itse:additional pages as ©ecessary,)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Crate: /
2/4/2011

L
tvision of Water Quality r"'�
E
cifty dumber �p a Q Division of Soif and Water Conservation
Q Other Agency
Type of Visit g>1(:ro_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 or Visit: Arrival Time: Departure Time: County: J� Vim- Region: I* -
49,10,
Farm Name: ar,.,t/ K �c+fs ��/»'t- /�1-dpi( Owner Email:
Owner Name: �n �- �f K a� s s _ Phone:
Mailing Address:
Physical Address: ;
Facility Contact: It .J,- 1 _3 nc� , Title: Jn }' Phone No:
Onsite Representative: h -ss Integrator:
Certified Operator: Operator Certification Number: 1925 0
Back-up Operator -
Back -up Certification Number:
Location of Farm: Latitude: = e =I =" Longitude: = ° =I 0 "
llesign Current
Design Current
Design Current
Swine LoapacPopulation
ity
Wet 1'oul#ry Calfacity Population
Cattle C•apac1 Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
IEJ
Non -Layer
I
❑ Dairy Calf
❑ No
❑ Feeder to Finish 40
[3 No
D Dairy Heifer
ONE
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ NE
❑ Farrow to Feeder I
--
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑Beef Stocker
Gilts
Non -Layers
❑ Pullets
❑ Turkeys
❑ Beef Feeder
❑ Beef Brood Co
P1_1 $oars
Other
❑ Turke Points
I ❑ Other
Num ioer of Structures:
❑ Other
Disrharp-es & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes %No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
❑ No
El Yes
[3 No
El NA
ONE
❑ Yes
ONo
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

.t
Facility Number• &e
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q1
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes O -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ®.No ❑ NA ❑ NE
❑ 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 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? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ 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 l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�rla_ /©Y�rSY�ef / l[%J� 54
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [SNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes N No ❑ NA ❑ NE
❑ Yes D!�No ❑ NA ❑ NE
Reviewer/Inspector Name ,'sY.t/ Phone: 3'33
Reviewer/Inspector Signature: Date: I1}
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection 1L1
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Q 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Kio ❑ 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 PS -No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C&No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EjNo
❑ 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
C�[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
SNo
[INA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
34.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
t@ 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
ERNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ERNo
❑ NA
❑ NE
-.- x
L;g �_ 3
Addirional:CommentsndlaeI?rawtrtgs °F •`� �" a'�
JL
Page 3 of 3 12128/04

Type of Visit IMompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit a Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: C7 Departure Time: ' County: Region:
Farm Name: V7 44 ba Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: y .�5 _ _ Title: AC _ Phone No:
Onsite Representative: Integrator: 62!21% j
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm -
Back -up Certification Number:
Latitude: = 0 =I = u Longitude: = ° = I = u
Design Current
❑ No
jiiiiiiiiiiDesigZ_=_
esign CurrentSwCapacity
Eopuiation
❑ No
Wet Poultry Capacity opufatou
Cattle Capacity Popnlafion
to Finish
❑ Layer
❑Non -La er
Dairy Cow
❑Dai Calf
to Feeder
Weeder to Finish �
ers
Dairy Heifer
Cow
❑ Nan-DaiLa
to WeanD
[:)Yes
w to Feeder
❑ NA
FCE]]Farrow
❑ Yes
w to Finish
❑ NA
Nan -La ers
Beef Stocker
❑Pullets
Beef Feeder
❑Beef Brood CoTurke
s
❑ Turke Poults ❑ Other
Mumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:)Yes
[RNo
❑ NA
❑ NE
❑ Yes
1,allo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection Ll
•
&�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
E�No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
{I( No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stnicture 1 Structw•e 2 Structure 3 Structure 4
Structure
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
Z No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
KNo
❑ 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
XNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q�No
❑ NA
❑ NE
maintenance or improvement?
Waste .application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LK No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)1 � - L( Y z iM/ ZtXGVZ
13. Soil type(s) _,Ljp zk�:P'd-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNo ❑ 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
Q .No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
YNo
❑ 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 Phone:
Reviewer/Inspector Signature: Dater
1228104 Continued

&0 �
' Facility Number: — Date of Inspection
Required Records BSc Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo �] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D(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 O.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA - ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes X'No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E{ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2�.No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
Xlo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
V�.No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
31 Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
;$-No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
El NE
Additional Comments and/or Drawings;
12128/04

ti
Type of Visit &'Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 011fo-utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Arrival Time: 10 3
; �� Departure Time: 10 County: J Region:
AV
�py
Farm Name: .t2ihywl��L Jr- Owner Email:
Owner Name: D2rTjfN tK4� Phone:
Mailing Address:
Physical Address:
Facility Contact: .,LLYIm to 17-$ .5 Title:
IF
Onsite Representative: �So
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [--]' =] ' ="
Longitude: = e ❑ , = «
Design
Current _6Esign
Current
Design C►urrent
Swine Capacity
Population VI'et Poultry -Capacity
Population
Cattle Capacih Population
❑ Wean to Finish
❑ Laver
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Yes
❑ Dairy Calf
Feeder to Finish
. _ • u
❑ Dairy Heifer
❑ Farrow to Wean
a
Dry Poultry h.
k w-
❑ Dry Cow
❑ Farrow to Feeder
_
-
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Beef Feeder
❑ Boars
❑Pullets
10
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkev Poults
❑ Other
❑ Othcr
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the Nvaste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of'3
❑ Yes [4 No ❑ NA ❑ NE
El Yes
❑No
DNA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ZNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R1 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JO No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
4 No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes
W No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes
j4No
[:INA ❑NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
�o
9. Does any part of the waste management system other than the waste structures require ❑ Yes
9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[M No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[RNo
❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Ycs
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ 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): s ``
~
Reviewer/11 nspector Name - - — �- � Phone:
Reviewer/Inspector Signature: Date: lie
Page 2 of 3 T - 1 12/28/04 Continued

FacilityNumber: W_�—&Jqp Date of Inspection eff
' 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 (3 No ❑ NA ❑ NE
the appropriate box. ❑ W'Up ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield Cl 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
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Pq No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ 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
® 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
00 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2q 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
04 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Page 3 of 3 12/28/04

G-11 ivision of Water Quality
Facility Number O Division of Soil and Water Conservation��
O Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit �'ioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: — 3"(7 Arrival Time: Departure Time: r � County: Region: ff
Farm Name: 42j2 k? It 3¢„6: 6!0" L P/:!V gOwner Email:
Owner Name: / Phone: ` U
Mailing Address: aq qy 1 Ii_ �c— _ _ C�� : h !f''^ rte' e•y�i'S 3��
Physical Address: r-� y�
Facility Contact: J a -n n Y 1\ ��� v Title:
Onsite Representative:
Certified Operator: e
Back-up Operator:
Location of Farm:
Swine
Phone No -
Integrator: yar-5 r�—
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =1 =" Longitude: =0=6
°=6 = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I 1 ❑ La er
❑ Wean to Feeder❑Non-La et
14 Feeder to Finish D
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Curirent,;.
Cattle Capacity . Population ...,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
i
❑ Yes [EI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
0 N
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[gNo
❑ NA
❑ NE
❑ Yes
C+No
❑ NA
❑ NE
12/18104 Continued

}
Facility Number: — p Date of Inspection 7
l
[4No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[—] Yes
Waste Collection & Treatment
[]NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IgNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
® No
J
❑ 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
N No
❑ NA
EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
4 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
ANo
❑ NA
❑ NE
8. Do any of the stuetures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ 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
Zvo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ANo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JN No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[4No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[—] Yes
[ No
[]NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question 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):
t
Reviewer/Inspector Name �/ '� Phone: ,10-- J3 3
Reviewertinspector Signature: Date:
0- 12/28/04 Continued

i Facility Number: —W Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design ❑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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [K No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5JNo
❑ 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) certification?
❑ Yes
§9 No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
�N 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
[Z 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
�€o
[:1 NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments and/or Drawings:
12/28104

1l�
Type of Visit M Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit J& Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: + tiQ Departure Time: County: Region: JfMQ
Farm Name: Owner Email:
Owner Name: , L,�l� S Phone:
Mailing Address:
Physical Address:
Facility Contact: Q M r? T75a 15 Title:
Onsite Representative:
Certified Operator:�-
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o Longitude: = ° = I ❑ u
Design C•nrrent
�. __ Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
�.
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ NA
❑ NE
❑ Wean to Feeder
❑ Non -Layer
❑ Yes
❑ Dai Caif
❑ NA
❑ NE
Feeder to Finish `) Q d
�:':3> � '� ��"`"'
❑ Dai Heifer
❑ Farrow to Wean
D , Poukt '. "
" ❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑ on -La ers
Beef
❑ Beef Feeder
PBoars
❑ Pullets
Brood Co
. -
❑ Turkeys
s
Outer
❑ TurkeyPouits
❑ Other
i time
❑OtherEE
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
9) No
❑ NA
❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
R1 No
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
�0 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Q Date of Inspection ED0.
r� Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ 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 appropirate box.
❑ WUP [:1 Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 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
Q No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
jo No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
� No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
$4 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
O 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
13 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Add�tioinaltCoinments andlor Dir �W"gs
,.
12128104

12- Crop type(s)
Facility Number: Date of Inspection =34` 0("'
? Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
RNo
[INA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
EfNo
❑ NA
❑ NE
Spillway?:
❑ Yes
OdNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
jo No
❑ NA
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
4 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
—P-R"No
❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CK No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12- Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JNNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
EfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
OdNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jo No
❑ NA
❑ NE
Good roe-,r&
x ^: �;r' .
Reviewer/Inspector Name17
"' _ , Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

le
® Division of Water Quality
F `Cli Nu t
t. b r $02 (e O-] O Division of Soil and Water.Conservithon ,t i
yrs- O Other Agency
P
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
i
5
Date of Visit: ArrivalTime: Departure Time: County: 54w• W000 Region: F12v
Farm Name: ars n a sS a�� .�+-. ' Owner Email:
Owner Name: ��A%s Ilk Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: a..,.., a s s Integrator: pr•.e 5A, e.
Certified Operator: 4�v...� _ ��.a Operator Certification Number: 4 k �S4
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o ❑ I = Longitude: =0=
0= =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I 1 ❑ Layer
❑ Wean to Feeder L 1 10 Non -Laver
Feeder to f=inish a7 ,24
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-tnadc?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State'' (I f yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 111,
d. Does discharge bypass the waste manaaement 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 50 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ju4 No
❑ NA
❑ NE
❑Yes
MNo
DNA
ONE
12/28/04 Continued

Facil�Number:—+re07Date of Inspection 4 Dr na
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1. Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �. f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RI 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 ® No ❑ NA ❑ NE
8. Do any of the stuetures lack adequate markers as required by the permit?
❑ Yes
91 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
❑ 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)
13. Sol] type(s) a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EM No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`[]
Yes
W No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
' w&s' ,add or any
Reviewer/]ns peetor Name m c r""; �`�"' Phare:
Reviewer/Inspector Signature: NP Date: L O81�b�
12/28/04 Continued

Faci[jWsVutuber: go;71 (�b pate of Inspection /ems
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U] 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 El Checklists El Design El Maps ❑ tither
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 ❑ Stacking ❑ 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
10 No
❑ NA
❑ NE
21
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
® No
❑ NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PEAT) certification?
❑ Yes
❑ No
❑ NA
P?] 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
[,VNo
❑ 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
[t 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
[X No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
12/18104
P44Ct Lo., r-C.C4�GC s arw� rt.G.Orda .
12/18104

V
Type of Visit 9 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0 Routine Q Complaint Q Follow up O Emergency Noti%ation Q Other ❑ Denied Access
Date of Visit: y -/L! d LI Tae: ' v P
Facility Number L p'j
Q Not Operational Q Below Threshold
Elfermitted 0-Cerdfied 13 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: . County:
Owner Name:.Ct!tf4.L1_�A_..p�S�%��.�.. Q•,al _.�vr% .!A5,� c.�.ic�1--..... Phone No:
_Mailing Address: ....P:..:._X-.....1I4`1..._...� ��:'i :�clr.�........ N �.. P.S �? rl _.__......._..... ..... .
Facility Contact: ....... Q&.-7.& Title: Phone No: Cc II I r?�n-rya-9576
Onsite Representative- .. m Integrator: E _ a
Certified ©perator:.� .._.,pct rat . . - L� .. _ uSS- T Operator Certification Ntumber.-_..Z, 3 E, _,____,
Location of Farm:
atwine ❑ poultry ❑ Cattle ❑ Norse Latitude • ` " Longitude 0 ` "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes S-?"
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes e -No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes B -56-
c. If discharge is observed, what is the estimated flow in gallmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ITNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑M6
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j3la
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B -Piro
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ...................... ,.... ...... ..... -............................ ......................... _........
Freeboard (inches): 31
12112103 Continued

° tc".3
Facility Number: -- Date of Inspection `/y-oy
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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes 31 o
❑ Yes 3-1�0_
❑ Yes [314-0-
0
3'Na❑ Yes C3 No
❑ Yes [TNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes E3*
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes U -No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crop type [nUS�a VG�rv�ufc f ff�y�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M -No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 9No
b) Does the facility need a wettable acre determination? ❑ Yes 9NO
c) This facility is pended for a wettable acre determination? ❑ Yes [-leo
15. Does the receiving crop need improvement? ❑ Yes [}No
16. Is there a lack of adequate waste application equipment? ❑ Yes [-Ne-
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 BN -o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes UNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Q -No
Air Quality representative immediately.
Com ats (refer to gaesban #) )diptaja any YES answers a d/o s y r ecoam�adado is or. any Other co�ea f
e i ..Y � ,- -
3Lise drawings of iactTity to better explat<n srtnattions. {ase sddYtaanal pages as neaesSary� ' # [t}eld Copy ❑ Final Notess l- b
ReviewerAnspector Name : t � .p„ m
_t
Reviewer/Inspector Signature: (� Date: - ► lf- U
12112103 Continued

Facility Number: Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
9 -NO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Croy j;'�% Far...J feo"V in .l
L
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
U -No
23. Does record keeping need improvement? if yes, check the appropriate box below-
❑ Yes
EaNNo
❑ Waste Application ❑ Freeboard' ❑ Waste Analysis ❑ Soil Sampling
Mr, 'Of -s-50-/-
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
B-90
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
G�No`
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
❑o_
(ie/ discharge, freeboard problems, over application)
❑
Fa r X)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
[;fio
2$. Does facility require a follow-up visit by same agency?
❑ Yes
M-ido
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
G -No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
des
❑ No
31 _ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O -No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
BfgO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [ O
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ONo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Add ltional Comments andlorDrawcngs r
v ,Ill - •9. :' e -_'_x17- _ ./...ewk�� '::..ter"' :l-.. _..a.. _.,.. .: -.*1-- C�' :1'•'.,�„e" .K .««s;..'_ :.-= Y-.��......:.:.s'$ .- .L.-= P� _ ::. �..-. e..
�r. nasi
Pans -f o st!arf vS;„9
Croy j;'�% Far...J feo"V in .l
L
Seas on,
Mr, 'Of -s-50-/-
Pr% 77
Gr
p�rr����t �a � l"S t
�
/�
��G/�5
G7LGd�l/�„1 J
RQ( Orch
urt well
Fa r X)
;_5 well ketol,
12112103

Site Requires Immediate Attention: nl o
Facility No. 3=a-9
DIVISION OF ENVIRONMEN'T'AL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
�
Fla'S '
Farm Name/Owner: Vr e
Mailing Address: �o
County
Integrator:
On Site Representative:=
Physical Address/Location:
DATE: 1995
Time: y = (Id
Cg6
Phone:
/YI c Phone:
7
Type of Operation: Swine •/ Poultry Cattle
Design Capacity: _ 2 ,Sq c . _ Number of Animals on Site: :3_ Zg,:5-_ 0 S
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon havsufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) jes,%r NoAga Freeboard: ,I Q _Ft. Inches
Was any seepage observed from the laM�No
{s)? Yes oWas any erosion observed? Yes o;Q
Is adequate land available for spry? Is the cover crop adequate? Yes or No
Crop(s) being utilized: 'C�� sf4
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Xeor No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 1a
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes -16r If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: _ �.w 1� � 3 h o g ie s
Inspector Mame
.l—
4 A'7
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
NORTH CAROLIM DRPARTNMgT OF J2?VZ 0NXE2T, HEAT TH A NATM:LkL RXSOUPJCES
► •: t - La ■a r r "Is to
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
All questions answered negatively wi22 be discussed in sufficient detail in
the Comments Section to enable the deemed Pe=ai ttee to perform the appropriate
corrections:
SECrION I
Anirtal Ooeratiori.T Pe: TT --c Ci {o Fi6tSk
iiotses, cattle, swt ine) poultry, or sheep
SECTION Ii
M© ►�
1. Does the number and type of animal meet or exceed
the (.0237) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with licn:id waste
sys�asa) j '
2. Does this facility meet criteria for
Animal operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a CZRTIFIM ANnIAL
WASTE NAKAGEliFM PL7A ?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6_ Does this facility meet the 5C$ minimum
setback c=iteria for neighboring houses,
wells, etc?

S�GTSdN III
4
ld-Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Slue Line Stream?
2. is animal waste land applied or spray
irrigated within 25 ft. of a USGS clop
Blue Line Stre=?
3. Does this facility have adequate acreage
on which to apply the Waste.?
4. Does the land appliaation'Site have a
cover crop in accordance'with the
CFS I ICA7IDN PLAR?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the anneal waste management at this
farm adhere to Best Management practices
(B' ) of the approved QTTIFICATI4N?
7. Does animal Waste lagoon have Sufficient
freeboard? How much? (Approximately ?
A. Is the general condition of this GAFO facility,
including management. and operation,
satisfactory?
S!2 T 014 IV
Co=ent s
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4/
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67 f�
C S B FARMS
From Keener take 701 North
and turn right onto RPR 174ti-
and then. take first road
to the left CSR 1738). Go to
stop sign. Go straight
across to SR 1736. Farm is
1 mile on the left.
y
�
f� •
C*
�
C S B FARMS
From Keener take 701 North
and turn right onto RPR 174ti-
and then. take first road
to the left CSR 1738). Go to
stop sign. Go straight
across to SR 1736. Farm is
1 mile on the left.

1621= r. AM -T-3 'LLQ2LAM C31Z_C.'-C ^:: ^rbT FOR 'HIM CR Z=A2r4_I= ?==Ts
?laaas rtt. == thO ce-MXPlntrd faa TO Ito Mv=sfosz of at
:v WNSOs OA th,* r4v4L:.aa sida of tin fC=.
Vane Of fa := (?lease Yr .zt) : C- r`A2nm I - z 4-
;d: -Mess:
04__DaaWte 110'9
SnUIH Fre(.0 J G :.75Z7^ ?home NO.: 212 - 4-
CounC'y: SAM��oc1
Fa^ locacior-: _acs=ice an Lang_ -ode: e /o' fir' /Ze Lfi� U`' (_�^" �ec) ?� a.
_� .__
please ac4ae:- a copy of a county road map with location identified.
Tyle of operation C.-rwi ne. layer, daisy, cc } :&iil ' _
:es_Tn Capacity (.^.=nVe; of ai;i=als } 2940 E99D - AR -M4
Avermse► sire ..f creat_ (-_ =cw : ocpu_aC,on avg.) :294e 'eE.O-Fin�SN
Average acreage needed for land appl_cacien ..f waste (acres) _-2--3..5_ ,
=moa==allay yytsaaaaalsss =sasaaasassmum=maasaa7tataw 727===Ma=ria==m==m aas:=aaa u 3aaae=
$7j ec;alizz Car'-_!Lcatioa
:�s a t ...^.3. specialist des_g_nacec by the Vcrmh Ca=ol na Sail and avatar
Wnse=vacion. Lr==Vssion puzsL;a=t to 1SA NCAC ox .0005 term__! that =he new ar
expanded a.�•�' wast_ =a^.agezent systam as L sta_lea for - .a `__= nz=.e= move
:as an aniz._ waste ma=n- gement plan that meets the desisr:
operacicn &Md st:Andaxds and Spec ___cacicrs of ..fie Div.sioa of
Z.'r_=or•_me.n=a MOzayeme_nZ and the USUA—SoilWreset =aci :i1 SerACS and/Cr the NOZI.L
Carolina Sail and Water Camservacicn Cc.=_Ssicz: u=suAwA w ON NOW 2H.0217 and
__ : VC=.c 5= . 000'_-.0005. 'Me 011cwi g 41 omen=s and _nes= ccr=esponding -•in!==
by ae or other desi;nacad tach—cal specialists and
are included iz,_ the plat_ as applicable: ==:.num separations (buffers) . liners or
eg*__ralanz t.._ _agCCns or :ratite st..r'1ge ;;cnds; waste stzr=ge=apa.:_ adequate
cganti Y and amcUZZ of laZ4 for waste Umilization. (or use of thi_a Par=V) ; actress
ownership of ;rope-- :waste application equipment; schedule for timing of
z7plicati0rs; applicaZ!*rL rates; lcad.,L g rates; and t2ae control of =s disc_ a-= e
Ci goi].utarts from ranoff events less severe t^.ar. mhe 4S -year, 24-hour
Sywrm.
NA=A a! Tec!:--uCai Spacla'lat (Please ?_int) �'- �ZcBr7n C��Fron
A_____at_o PRE rpar F.� c
=tddaSS (Age-r.cy)P.C. 430, 44A Vz1177o i a .Z8_3zFiPhone Vo.59z- :2 7-7'
S _ ,:.at•..re - ..... Came; 5I 14 / 9�
�xaaa.9�a3asa3aaaaasa�as:aasaaassaaatstssaaaaa s�sateasaatasa a=a: aaaaz�aaa Sas
Gtr-'eL /X=age= Ag=a4=&mt
(:re) t_=derstard the operation_ and mai= =mance prweduzes establish ed in the
a=pr„ved a213.=a; .haste =ar.ase--menc plan for the Qx=i named a.nnve and will _? amen=
_ese -=roced- =es Z (we) )mow that any acd'_t-xp
ona? ar.sion co z: a existin
.s
designcapacity of the :taste ..wea=ment and storage System or cC^5t_ 2C=_Cn of new
:ac_____es will =Mqu i=M a new ce=--__cat_an to he suh=:Ote` =a the Uivision of
zz _route_nca_ MI.nageTwns before the new an-L-nals are st,cked. _ ;we} also
.._:erStand that here W::St be no dlscnarye of an0al waste -_== this system to
s:._=ecce wacers at" the state e=ther a :::an -made cC .•reyar.ce or
:n=off f=== a st :^ even= less severe than the W -/ear. 24-^C.-= st=r M. The
ac_ =ved plan will be filed at the fa_= a -d at the office of ttie local s4__ and
Wace_Corset !allot: District.
:ia.=a G.� td .4; yi�4l (p1aa.Sa ;)=:."t) ^F!_AfZMS AL. �)1,r1y �. Q
A sS
Dater �g�-
:xA=a Of Zara if a___erenz from owner (?lease print) .)Anny BASES
Date:` J
2=3: r, C= ange _. j .d ownership recFuizas noc:r_calinn or a new ..erre_icaciCn
(__ the aq;r= -e_ plan is c4anged) to :e suh=i=te to _--s ==-r_s_oa of
I..viz=,a ental Ma_agame.^_t within 60 caws of a title t_ansfar.
C''EM- USE 0.4LY : MrZ

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