820583_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: (B'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &)-koutine Q Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access 11
Date of Visit: Arrival Time: ! J Departure Time: County: Region:
Farm Name: , So V� Owner Email:
Owner Name: ty, }� fy �_ Phone:
Mailing Address:
Physical Address:
Facility Contact: 'L,, -45,,f, 1042 -tv. Title: Phone: '
Onsite Representative: l Integrator: (/t1
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
's "'`Desigu Current
Design Carrent
{
Capacity Pop.
L�1Gj
Wet Poultry ACapacity Pop.
Gattic Capacity Pop.
1A
❑ NE
Wean to Finish
I 11-ayer
Dairy Cow
Wean to Feeder
I
INon-Uyer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Carreat
DryCow
Farrow to Feeder
O Potttt . < - Ea acit P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
4`
OtberTurkey
Poults
' 13
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E9 ""' ❑ NA ❑ NE
❑ Yes
[—]No
Er A
❑ NE
❑ Yes
[] No
1A
❑ NE
[] Yes ❑ No
❑ Yes 0i o
❑ Yes TNo
Ia A ❑ NE
❑NA 0 N
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

Facifi Number: WT - S C-3 Date of Inspection: 31
❑ Yes
1 J "'o
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
En No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Waste Application
Spillway?:
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O—No
Designed Freeboard (in):
❑ NE
maintenance or improvement?
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg-igo
❑ 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
awo
Ej 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
1 J "'o
❑ 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
0 Yes
[3No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O—No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window p Evidence of Wind Drift p Application Outside of Approved Area
12. Crop Type(s): 13 eq4t 4I ct S (-) 0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required 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.
[:]Yes E'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes <No
NA ❑ NE
❑ Yes ❑ NA ❑ NE
[] Yes [/]"No ❑ NA ❑ NE
[:)Yes LD No ❑ NA ❑ NE
❑WUP []Checklists ❑Design ❑ Maps ❑ 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 ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 91 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
0 N 0 N
Page 2 of 3 2/4/2015 Continued

Facili Number: K,4, jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E"'o
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [T No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0_1q0_
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes O No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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/]nspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
F] NA ❑NE
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [3] No ❑ NA ❑ NE
[:]Yes []'(`Io ❑ NA ❑ NE
❑ Yes [j] No ❑ NA ❑ NE
❑ Yes �o [:INA ❑ NE
❑ Yes [?No ❑ NA ❑ NE
❑ Yes [ZfNo ❑ NA ❑ NE
❑ Yes FANo ❑ NA ❑ NE
s
Comments refer to ueshan �Ei law su ;YEanswers and/or -an additional recoutmendations°or an ether, comm_ ents.�:
� - ; � S-
�,•� !���I' ill ����,�. - ', e tlr vwim of_facrlr to better- ex lam sitnatrons ase ad Monal pages as necessary}. �
� r �
Reviewer/Inspector Name: j V
Reviewer/Inspector Signature: `
Page 3 of 3
Phoned!_(- 1A.3— 73 3e
Date: , jot
2/4/2015

Type of Visit: omplionce Inspection 0 Operation Review d Structure Evaluation Q Technical Assistance
Reason for Visit: 0-lRoutine O Complaint O Follow-up 0 Referral O Emergency Q Other © Denied Access
Date of Visit: Arrival Time: Departure Time: County: TV41 Region:
Farm Name: Owner Email:
Owner Name: t, ` C Phone:
Mailing Address:
Physical Address:
Facility Contact: kz Title: Phone:
Onsite Representative: t Integrator:
Certified Operator: ) Certification Number:. /q AO 7
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
SwineGapaelty Pop.
Wean to Finish
Wet Pqultry
Layer
Design
Capacity
:Curre`�` n_
Plop.
7l9 ��� >" Design Current
Cattle Cap city Pop.
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
°-'"
❑ No
�A
Dairy Heiler
Farrow to Wean
❑ Yes
Design .
CUl Feist.
D Cow
Farrow to Feeder'
D . P,oul
CaRaeit
Po
Non -Dairy
Farrow to Finish
La era
❑ No
dNA
Beef Stocker
Gilts
Non -La ers
6N
❑ NA
Beef Feeder
Boars
Pullets
El No
❑ NA
Beef Brood Cow
of the State other than from a discharge?
Turkevs
Other
TurkeyPoults
a, `a„ , -
Other
Other,
Discharges and Stream Imnacts
I. Is any discharge observed from any part of the operation?
❑ Yes
B<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�A
❑ NF
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
2l A
❑ NF
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
dNA
❑ NE
2. Is there evidence of a past discharge from any pari of the operation?
❑ Yes
6N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
El No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Fadi Number: H
jDate of Inspection:ZLEEZ, 171
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [i - o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No Q -4-4A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t_-' o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fNo
❑ NA
❑ NE
(not applicable to rooled pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3 -go
❑ NA
[] NE
maintenance or improvement'?
Waste Application
10. Are there any regyired buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes [Er<o ❑ NA
❑ 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 F1 Evidence of Wind Drift E] Application Outside of Approved Area
l2_ Crop Type(s): � ;f V, Ak U�6 t# _ -C &—_0
❑ NE
13. Soil Type(s).-
14.
ype(s):14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 --No ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E:Wo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®'Ko ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [;14o ❑ NA 0 NE
❑ Yes ❑201 fo ❑ NA ❑ NE
Reouired Records & Documents or
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes ff No ❑ NA [] NE
20_ Does the facility fail to have all components of the CAWMP readily available'? Ifyes, check ❑ Yes FI.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 ❑14o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes ❑! No
❑NA C] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection: v
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Gj,,K'o ❑ 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 g? No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes g'lgo [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
❑ Yes �o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
E3"'No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
[]Yes
Eff No
❑ NA
❑ NE
Phone:&W-3,334
Date: 0 K 11
Page 3 of 3 21412015

e Fe& 16
Type of Visit: Qom ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ` County: 1-w-' pi Regio
Farm Name o �pl� Owner Email:
Owner Name: L- Phone:
Mailing Address:
Physical Address:
Facility Contact: L L! j Title: Phone:
Onsite Representative: ( ( Integrator:
Certified Operator: L
Back-up Operator:
Location of Farm:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
[::]Yes
❑ No
Current
Design
Current
Design
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Ca.06
ttle Capacity
Pop.
Wean to Finish
❑ NE=
2. Is there evidence of a past discharge from any part of the operation?
La er
CalTo
❑ NA
❑ NE
Da' Cow
Wean to Feeder
RNo
❑ NA
Non -La er
of the State other than from a discharge?
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
.,
r�
Design
Current.
D Cow
Farrow to Feeder
D , P.ou
Ca aci
Po P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-Layen
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkeyPoults
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?
❑ Yes [�q �❑ NA ❑ NE
❑ Yes ❑ No ❑' lA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[::]Yes
❑ No
L--t'1qA
❑ 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
aNA
❑ NE=
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CalTo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RNo
❑ NA
❑ NE
of the State other than from a discharge?
,Page i of 3 2/4/2014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Epiv-❑ NA ❑ NE
a_ if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑.N*—❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
❑ Yes
Identifier:
❑ NA
❑ NE
Spillway?:
❑ Yes
Ea No
Designed Freeboard (in):
[] NE
Required Records & Documents
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q -Mo r
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes E]4K
❑ NA
❑ NE
waste management or closure plan?
[] NE
the appropriate box.
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes D -N6
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E2,Ko
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
21. Does record keeping need improvement? If yes, check the appropriate box below.
9. Does any part of the waste management system other than the waste structures require ❑ Yes [f"lio
❑ NA
❑ NE
maintenance or improvement?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [T5'o
❑ NA
❑ NE
maintenance or improvement?
22. Did the facility fail to install and maintain a rain gauge?
❑ YesNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (-]No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ Yes
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ NE
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
%jWindow
12. Crop Type(s): S 6 0 pa'c
2/4/2014 Continued
13. Soil Type(s): 'v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ED�Xo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � E] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q. -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ea No
[] NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
[] NE
the appropriate box.
❑WUP E] Checklists ❑Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
[] Weather
Code
❑ Rainfall [] StockingE] Crop Yield [3 120 Minute Inspections C] Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesNo
9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

'93 Facili Number:Date of Inspection*.
24. Did the facility fail to calibrate waste application equipment as required by the permit? H Yes ❑ No
25. Is the Facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ [Von -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? 0 Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑ NA 0 NE
[] NA ❑ NE
[] NA ❑ NE
[3 NA 0 N
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
❑No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[] No
0 NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
omments (refer to question {i): Explain any.YES answers and/or, any. additional recommendations or?anyMoth�r eamptents'. �;
Fuse
draw"rnEs of facility #o better explain situations'(use�addidoual pages as necessary),
r ig '
__ .._
t., I �, du4r eNc,p'E-NZ,GOO
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone: P�
Dale:
21412014

JType of Visit: ErCommplianee Inspection U Operation Review Q Structure Evaluation U Technical Assistance
1j Reason for Visit: Gloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Or Departure Time:'li j <c)� County: Yy! Regiondl 7—Te "
Farm Name: 44tAJSq, 6 a& Owner Email:
Owner Name: 0#0a Phone:
Mailing Address:
Physical Address:
Facility Contact: L�- �vC S' ted Title: Phone:
Onsite Representative: Integrator: J;�F
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
Layer
Non -Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cqw
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D , P,onl
Ca aei
I
Da' Keifer
DCow
Non -Da'
NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Farrow to Finish
❑ No
Layers
Beef Stocker
Gilts
Boars
Othe
Non -Layers
Pullets
Turke s
urkey Poults
Beef Feeder
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Beef Brood Caw
❑ No
[NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
Other
Other
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
f nNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
El-blo-8 NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Q VAAA
NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes
❑ No
a<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
❑ No
[NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
f nNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

FaciliMember: - Date of Inspection: w,
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 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes LY -K_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
2,N ❑ NA
❑ NE
waste management or closure plan?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yesfob
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental notify DWR
7, Do any of the structures need maintenance or improvement?
E] Yes
'7
'o ❑ NA
❑iN
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑.I16 ' ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q Alt- 0 NA
❑ NE
maintenance or improvement?
Ga<o
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
❑'lqo— ❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[2fl�o
[DNA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑'�Io I ❑ 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): &,:2( " s C) `cx
13. Soil Type(s): Cr�A
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes Er5o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yesfo ❑ 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 laud application? ❑ Yes rio ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes F2to ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yesfob
E] NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E2'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.
0 Yes
Ga<o
❑ NA
❑ NE
❑ Waste Application 0 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
[2fl�o
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
�j'No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

F-ftciliNumber: - Date of Ins ection: IL;
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z.�F[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑wa'�❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Nan-cornpliant 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 [_-lqo❑ NA [:]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3-<_ ❑ 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 To ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L, Ko
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
❑.• ' +lo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
014o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Flo
❑ NA
❑ NE
Comments (refer to question #1): Explain any4YES.answers and/or any additional recommendations or any other cuiuments - -
Use drawings of facility to:better explain s tiaatiians {use additional pales as Qecessary).
-
C�jl�e'410V�—
�: zduj-� —
4
Reviewer/Inspector Name:
Reviewer/Inspector Signature: [
Phone:
Date:
Page 3 of 3 It 214/2014

Type of Visit: CrCom ' nce Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
4(1
Dale of Visit: Arrival Time:llt 75 ! Departure Time: r �� Conn . Regiol�
Farm Name: _Age' l -Sp +.�� Owner Email:
Owner Name: f G Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
L ".et, 1',,d4 Title:
Phone:
Integrator: f Mt..{
"( 12497
Certification Number:
Bach -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C -arrest
❑ Yes
Dcsign
Current
Design Current
Swine Capacity Pop.
Wet Poultry
.`'rEapacifir
Pop.
Cattle Capacity op.
Wean to Finish
I.a er
[:]No
NA
Dai Cow
Wean to Feeder
Non -La er
No
❑ NA
Dai Calf
Feeder to Finish
y g.
` ' '
Dairy Heifer
Farrow to Wean
❑ Yes
No
nt
Dry Cow
Farrow to Feeder
Dry Poul
Ga aci
Po P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Beef Brood Cow
Boars Pullets
Turkeys
Other
Turkey Poults
Other Other
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation? ❑ Yes A ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Lj.�KA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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 2/4/2011 Continued

Facility Number: YLDs ection: f
*Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 31 o [INA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No [;3-"A ONE
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 inte&rrity of any of the structures observed?
❑ Yes
D -Wb_
❑ 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
IJ'r"u
❑ 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
Q_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
Ej. o
❑ NA
❑ NE
maintenance or improvement?
Waste Agplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F? -'5_o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
0 Yes
[a<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Dn-rACAA S:� G o
- —
13. Soil Type(s): 624
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C�J<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3to
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
DIG-
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ek<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �lo ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check: [:]Yes 2—go ❑ 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 L:14o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dWNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Condnued

Facili Number: Date of Ins ection•
•24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eg-Mo ❑ NA ❑ NE
10
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑- o_ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 'B ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes G].NiT- ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 [44Z— ❑ NA ❑ NE
❑ Yes Ea4115❑ NA ❑ NE
❑ Yes E3'<o ❑ NA ❑ NE
Yes LTJ "o ❑ NA ❑ NE
❑Yes�No
o ❑NA ❑NE
[:]Yes ❑ NA ❑ NE
(Comments (refer to question #) Explain anyYES answers and/or any additional recommendations.or,any other comments:` ' 'I
Use;drawin>;s'of facility to better eaiplairi situations (use additional pages as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
61-3
Phone: S.J` �S s
Date: 5
2/4/2011

(Type of Visit: Q omp fiance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: vutine 0 Complaint 0 Follow-up 0 Referral 0 Emerzency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,Yp Departure Time: County: �
ity vim— Region: '76711))
Farm Name: "O(±5y �0�� �}pc4 - Owner Email: �
Owner Name: iLQ��dt rp Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: integrator:
Certified Operator:
Back-up Operator:
Location of .Farm:
Latitude:
Certification Number: 1 }/J Z
Certification Number:
Longitude:
Discharges and Stream Impacts
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 21 No ❑ NA ❑ NE
[] Yes
❑ No
❑ NA
` "
❑ Yes
❑ No
❑ NA
Design Current
Des[gU'WjU- rrent
Design Current
Swine
Capac[ty Pop
Wet Pnuttry
Capac.tty,op
Cattle Capacity Pop.
Wean to Finish
Laver
Dai Cow
Wean to Feeder
Feeder to Finish
-Layer
Dai Calf
airy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
1)rr° l?otiitry
Ga ac[`�"Pbo ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other 0"
Other
Turkey Points
Other
Discharges and Stream Impacts
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 21 No ❑ NA ❑ NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

r acility Number: - Da#e of Inspection:
[:]Yes
® No
❑ NA
Waste Collection & Treatment
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JE No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
0 No
Identifier:
❑ NE
the appropriate box.
Spillway?:
Designed Freeboard (in):�
Observed Frceboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
KNo
❑ 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
g!] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ama94
I3. Soil Type(s): PUI
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JE No
❑ NA
[] NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes S No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes g No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

tFaEat Number: f5jte of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IS No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes aZ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
[]Yes
[Z No
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Vj 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
(A No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[]Yes
[Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: �y�_--
21412011

aype of visit: k-rx ompuance inspecnon t> uperanon tceview V notructure Evaivauon U itecnmcat Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: F2_
Warm Name: ��ty {.�S �V �€� pr_C1_�t S� Ej' _ Owner Email:
Owner Name: F- A sik (D _?b m ^� Phone:
Mailing Address:
Physical Address:
Facility Contact: Ljn p qg�:4 pap Title: j2Li nf-R Phone:
Onsite Representative: 'jpq- e: Integrator: PRl:gAw 3 9 -
Certified
Certified Operator: ea AmCertification Number: i CI %n q rt
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischargesand Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
`
Design Cuirrent
❑ Yes
Des'igq.-
'Current
❑ NE
Design Current
❑ Yes
Swine
Capacity Pop.
.}Wet Poultiv
Capacih°
Pop.
Cattle
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
t jg L%so
Layer
Non -La er
r
y` '�
0 NE
Da' Cow
Da' Calf
eifer
Da' Heifer-
❑ Yes
® No
❑ NA
❑ NE
Fato Wean
to Feeder
to Finish
❑ Yes
D . 1?ou!
Layers
Design
Ca aci
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Page 1 of 3
Non -Layers
2/4/2011 Continued
Beef Feeder
EGilts
Pullets
Beef Broad Cow
Turkeys
Turke Poults
Other
Dischargesand Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
r
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
t
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)
0 Yes
❑ No
® NA
0 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
. ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2011 Continued

5'
Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? F] Yes ❑ No ❑ NA [] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[A No
❑ NA
Spillway?:
the appropriate box.
Designed Freeboard (in): 1�'1
❑WLTP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
Observed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
V] No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
[-]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[4 No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
(� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4.6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[@ 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
D Yes
[v7 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑` Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Typc(s) -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 4 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?
Reauired Records & Documents
❑ Yes � No [] NA ❑ NE
❑ Yes 2] No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[A No
❑ NA
❑ NE
the appropriate box.
❑WLTP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
V] 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
[4 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 2/4/2011 Continued

Facili Number: - Date of Ins ection: ia g1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non-compliant sludge Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [54 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
N6
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? 1f yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Fond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[]Yes
[Z No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes]
No
❑ NA ❑ NE
otttmen s (refer o: question Explain an answers
q. ). p y and/or an additional recommendations or.an* other comments.
y
Uie:drawtngs:ofaeciLty to better explain stluahons.(use ,a
additional pages as necessary).
Reviewer/Inspector Name: ty.1 I % _ d
Reviewer/Inspector Signature:
Page 3of3
Phone: CN3-3p3-i0tSI
Date: �rid I
2/4/2011

rype of visit: ompliauce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ILlJ Arrival Time:,� Departure Time:I County: Region:
Farm Name: 1t? S`7 f j j� Owner Email: _
Owner Name: Phone:
Mailing Address: _
Physical Address:
Facility Contact: 't OCILf �p�{i Title: / Phone:
Onsite Representative: P -s Integrator: �-
Certified Operator: Certification Number:
Back-up Operator. Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. We# Poultry (C.4 Ai Pop. Cattle Capacity Pop.
Wean to Finish Layer Dai Cow
s
Wean to Feeder
Pullets
Nan -La er
Dai Calf
❑ NE
Feeder to Finish Dai Heifcr
Farrow to Wean Desig5 Current D Cow
Farrow to Feeder Q . P,oul.. Ca acii�_ Po . Non -Dai
Farrow to FinishLa ers Beef Stocker
Non -La Layer
Gilts Beef Feeder
Boars Beef Brood Cow
Other
.,
0ttI .
12
W
Other
Pouits
❑ Yes No
J4
s
NE
Pullets
❑ No
Turke s
❑ NE
Turke
Other
Discharges and Stream Impact
1. Is any discharge observed from any pail of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0
❑ Yes ❑ No
❑Yes ULNo
❑ Yes
NE
❑ Yes
❑ No
❑ NA
❑ NE
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?
�No
E] NA
❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

FaciliNumber: - Date of Inspection: C
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 03 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �,No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[!�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1No [DNA ❑ 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): ti'C/"
13. Soil Type(s): -W-0 _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R -A No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No ❑ NA [:1 NE
[—]Yes [No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes jo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [S -No 0 NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JQ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C? No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1`7 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: J
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 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 Cj�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 We 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 EA No ❑ NA ❑ NE
❑ Yes JK No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes R No
❑ Yes ® No
[] Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendations or any&ther;comments
Udrawings of facility to better explain situations (use additional pages as necessarv3.
se
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/p— 33ao
Date: 4 _p2
214/2011

Type of Visit (!fCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint Q Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 1100 Departure rime; County. �Y`r Region: '
r
.r
Farm Name: �-: ���.�� /cc5� _^ Owner Email:
Owner Name: �� _ Phone;
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: / !/
Certified Operator: � � OperatorCertificationNumber:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 0d ❑`d Longitude: =0 01 ="
Design Current
Design Current
Design Current
❑ NE
Swine Capacity Population
Wet Poultry Gaparity Population
Carile Capacilation
❑ NE
❑ Wean to Finish❑
Layer
❑ NA
❑ Dai Cow
❑ Yes
❑ No
❑ Wean to Feeder
❑ Non -Layer
❑ NA
❑ NE
❑ Dairy Calf
Vgfeeder to Finish
El NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑ N ers
❑ Beef Feeder
❑ Boars
Mets
❑ Pullets
El Beef Brood Cow
❑ Turkeys
Utter
❑ Other
[] Turkey Poults
❑
Number of Structures:
Other •
Discharees & 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 [2qqo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
M.No
El NA
❑ NF.
Page 1 of 3 12/28/04 Continued

Facility Numiber: � -65w.-31 Date of Inspection
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Rlo El NA
[:1 NE
Waste Collection & Treatment
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q&No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
allo ❑ NA
❑ NE
Spillway?:
Does the receiving crop and/or land application site need improvement? ❑ Yes
Lallo ❑ NA
❑ NE
16.
Designed Freeboard (in): 49, -
[;:;I No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Observed Freeboard (in): -75-
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
J No ❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
J�ONo
❑ 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
4RNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
XNo
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Rlo El NA
[:1 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 W% indow El Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) I�� r�
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
allo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
Lallo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [] Yes
[;:;I No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Eallo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
J No ❑ NA
❑ NE
Comments (refer to question :#/):' Explain any YES answers and/or any�,recommendeitions or any,other'tommenlm.
Usi drawings' of facility tb better.explain situations..(use additional pages as necessary) y# 5 �Z„
Reviewer/Inspector Name I ` �/� ' ' r--•� k " PItone:
Reviewer/Inspector Signature: Date: -"20
Page 2 of 3 i 12128/04 Continued

isI Facility Number: — Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2FNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design g El 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 95No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IRNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(KNo
[INA
❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q�[No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
54No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
[:INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2jNo
❑ 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
51 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
2.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
[XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Ea No
❑ NA
❑ NE
AddltionRal Comments and/or.Drawings. , k_.3. _.
r
Page 3 of 3 12/78/04

Type of Visit IUCoommpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ denied Access
Date of Visit: Arrival Time: � Departure Time: ® County: Region:
Farre Name:�j1-;ns'c� P-- -�_ Owner Email:
Owner Name: 4? ,L� —C:." Phone:
Mailing Address:
Physical Address:
Facility Contact: = f n d -5�esr ! ade- __ Title: �llJf1��� Phone No:
Onsite Representative: integrator: ��'G--� _
Certified Operator: Operator Certification Number -
Back -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=0
[=6
0 is Longitude: =0=6
°=6 0
Design Current
Design Current
Design Current
Swine Capacity Papulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dairy Cow
❑ Wean to Feeder
❑ Nan -La er
❑ Daia Calf
❑ Feeder to Finish
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Paul#ry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
Turkeys
® No
Other
❑Turkey Poults
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ Other
❑ Other
Number of Structures:
other than from a discharge?
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
IN No
❑ NA
❑ NE
Diseharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

ti
Facility Number: Date of Inspection
Reviewer/Inspector Signature: Date:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / of
Observed Freeboard (in): _&
5. Are there any immediate threats to the integ=rity of any of the structures observed?
❑ Yes
(ANo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
allo
❑ 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
C,No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[2�No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C6No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tO No
❑ NA
❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:1PAN > ] 0% or l 0 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)/1G�
13. Soil type(s) X14L12
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (ANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes RNo [INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 9 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 KNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Cotnents(r"
efeir to question #) Explain any YES answers and/or any recommendations o- ny ether eomments _
Use drawings of facility to better explain situations. (use'ailditiuoaipoges es necessary):
- - 'r„
Reviewer/Inspector Name Phone: ,�/,��7j` t9
Reviewer/Inspector Signature: Date:
12/28/04 Continued

V
t Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [YNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C No ❑ NA ❑ NE
the appropriate box. ❑ VVUp ❑ Checklists ❑ Design ❑ Maps p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SNo ❑ 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
;KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
BNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ja 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
RLNo
❑ 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
JRNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�*No
❑ NA
❑ NE
Additions! Comments an"Wor0rawin
i
T
12/28104

Type of Visit OX6�m'pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ss c7 Departure Time: - County Region:
Farm Name: L `-U �e-ee_ Owner Email:
Owner Name: T�1dld� —� i�� Phone:
Mailing Address:
Physical Address:
Facility Contact: G` ` s�`1 �O/Ot! Title:
Onsite Representative: �'—
Certified Operator:
Back-up Operator:
Phone
No:
Integrator: �/z'y5/ r
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =O = 0" Longitude: 00 =' 0 "
Design Current � Destgn Cuurrreni , ' Design Current
p ty p_�p 'Jty p C apacity Pvpuiation
Swine Ca aci Po elation Wet HoulCaact Po ulai�on Hale E
❑ Wean to Finish ❑ Layer F ❑ Dairy Cow
❑ Wean to Feeder JE3 Non -Layer ❑ Dairy Calf
Feeder to FinishACP' Dairy Heifer
❑ Farrow to WeanD Poult r "� ❑ D Cow
❑
❑ Farrow to Feeder _ r "any. La ers El Non -Dairy
El Farrow to Finish ❑ Beef Stocker
❑ Gilts ❑ Non -La ❑ ers Pullets ' ❑Beef Feeder
C1 Boars ❑ Beef Brood Co
afik&❑ Turkeys
Other
Y.
❑ Turkey Poul
❑ C7ther ❑ Other Number of Structures:
Disrhar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Klo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EN No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J4 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: JZL 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 I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 9LNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): LZ
Observed Freeboard (in): ..3 e
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J@No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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 O No
[-INA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �Q No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
9. Does any part of the waste management system other than the waste structures require
0 Yes KNo
❑ NA
❑ NE
maintenance or improvement?
Waste Apulication
13.
Soil type(s)� {� _
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E![A10
❑ NA
❑ NE
maintenance/improvement?
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
14 No
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
CgNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 47-y4U,111, f 9G�Gd`5
13.
Soil type(s)� {� _
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
14 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?o Yes
fqNo
❑ NA ❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Yes
CqNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA ❑ NE
YF:3f:bkY:aY.'av:�di:aa.�'.. . --_...-4 <Y rs'�4:?.�4 .. Y •' - - icY -
Reviewer/Inspector Name p.,� Phone: � '5>
Reviewer/Inspector Signature: Dater _(0— ba
Page 2 of 3 12/28104 Continued

t Facility Number: — Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R!�No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design [I Maps El 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 l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0,No
❑ NA'
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
bio
❑ 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 (FLAT) certification?
❑ Yes
PI -No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
4 No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
R�hfo
[INA
[3 NE
Additional Comments and/or Drawings ;
Page 3 of 3 12/28/04

ivision of Water Quality -a7
Facility Number "� -�—® 0 Division of Soil and Water Conservation l/
Q Other Agency
Type of Visit ®C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' Arrival Time: !p Departure Time: .�l� County Region:
Farm Name: n� Owner Email: dor
Owner Name: jU4VA4 R2 PC Phone:
Mailing Address: 6o 71 tr _A/i'fdr'ic2X .. _ Z' : ,O *
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:4IrC�4�-.r-�
Certified Operator:
Back-up Operator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: =e ❑` =`f Longitude: =° =4
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
19 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
FI
La er
Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ® No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
1218/04 Continued

0
Facility Number:4.5` Date of /inspection
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment? ❑ Yes
[2 No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
25No
[INA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CgNo
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
NNo
❑ 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
P9 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
El NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers; setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/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. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EN No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment? ❑ Yes
[2 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name v� �`. Phone;
Reviewer/Inspector Signature: Date:
12/28/04 Continued

1
Facility Number: — Date of Inspection
f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5a No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
64 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
El Yes
®No
❑NA
El NE
❑ Yes
18 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
12/28/04

t
4�
- Division of Water Quality
==imfiiunaber �_ v 6 r3 0 Division of+Soil and Water Gooservation
0 Outer Agency �
Type of Visit_Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t0-1 routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Lather ❑ Denied Access
Date of Visit: Arrival Time: Departure Tiimme:County: Region: RID
; �
Farm Name: I- r Owner Email
Owner Name: Phone:
Mailing Address:
Physical Address: II
Facility Contact: L- ► Se—Title: Phone No:
Onsite Representative:
Certified Operator: _4".—
Back-up
ice
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =] ` F—]'=" Longitude: 1=1 ° 1--] 1 ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�-ii ❑ Non -La et
Other
❑ Other _ - - - - - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a- Was the conveyance man-made?
Cattle
Design Current.
Capacity Population
❑Dai Caw
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
❑ Yes CkNo ❑ NA ❑ NE
[--]Yes
RNo
[:INA
❑ NE
❑ Yes
EkNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Pj No
❑ Yes
LKNo
❑ NA
❑ NE
❑ Yes
Callo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection — (o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes EKNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �q
Observed Freeboard (in): -3 7
5. Are there any immediate threats to the integrity of any of"thc structures observed? ❑ Yes EgNo ❑ 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
19 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PNo
❑ 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
CKNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U3Slo ❑ 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 Dri1} ❑ Application Outside of Area
12. Crop type(s)+f
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZjNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Wo ❑ NA EINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'! 0 Yes RNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes MNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ®.No ❑ NA EINE
Reviewer/]Inspector Name � y � � ;' '�� Phone: Wo L#_A -/_5 y f
Reviewerfinspector Signature: Date: 'A (,-::i23 ra b
r1/z8104 Continued

Facility Number: Date of Inspection 16
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;gNo ❑ 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
JKNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XINo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
§kNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Callo
❑ 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
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CKNo
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
[K No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CZNo
❑ 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
J,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
CKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jg[ No
❑ NA
❑ NE
."`
Additional 6om i fsRatzd/or Drawm­'-"'-'!--'-';'. `
,
-' t
i:."
12128/04

k S Division of Water Quality`- b `
Fac><lt<ty number go,L�Mjfl,
.5�3 O Division of Soil and water Conservation
s , . "
eeq., D.Other Agency
Type of Visit 11 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G 9 Arrival Timc:: Q d Departure Time: County: J�,awpJA"
o� Region: `
Farm Name: L ; yase., (2o r_ _a,Ar h� I Owner Email:
Owner Name: 1- L Phone: 4 t 0
Mailing Address:
Physical Address:
Facilitv Contact:
Title:
Onsite Representative: L,-,,06
Certified Operator: 7, a pe 0 C
Back-up Operator:
Location of Farm:
Swine
QPhone No:
Integrator:. _ _ /_- r e % Imo_ �e_
Operator Certification Number: �3 X32
Baek-up Certification Number:
Latitude: =0 = =" Longitude: = n = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder 10 Non -Laver
® Feeder to Finish L q.PD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Lavers
Non -Layers
Pullets
Turkevs
Turkey Poults
Other
Discharges & Stream Impacts
1- Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ pairy Cow
❑ Dairy Calf
❑
Dairy Neife3
❑
Dry Cow
❑ Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: D 11
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'?
i4
❑ Yes (Z] No [INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04 Continued

Fgciiiity gumber: y,2, —5k& jk& Date of Inspection
[)-d No
❑ NA
❑ NE
Waste Collection & Treatment
® 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 t Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:`
Spillway?:
Designed Freeboard (in): Ar as
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[P 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
R1 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
(PNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
K No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
U 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. Soil type(s) //p /,,
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
[)-d No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
M No
❑ NA
❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date: gi / 9 / a..J-
12/.28/04 Condnued

Facility umber: k-1 —J-ir gi Date of Inspection G 9 0
Required Records & Documents
19. Did the facility fail to have 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 ® No ❑ NA ❑ NE
the appropirate box.
❑ WISP ❑Checklists El 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 21120 Minute Inspections ErMonthly and 1 " Rain Inspections [B<eather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ba No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
00 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
R NA'
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW M P?
❑ Yes
IM 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
[A 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
[,Y No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector 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
10 No
❑ NA
❑ NE
AddltitinaLComments4nd/or.Drawings: s ;
..0 C7CR i� t C7 �► o L C i 07� art "'T .� Y l? y t� t 48 t,._
146, Ga .ti � �,.4 3r z� 1j�� 14T a �a� ,t+ 1 �q c s K �►., c� .
/2/28/04

Type of Visit *Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: _� �i-a Time: 9.3d
Facilih_- Number �
=Not erational 0 Below Threshold
Permitted (31--ertiffed 0 Conditionally- Certified ❑ Retistered Date Last Operated or Above Threshold-
Farm Name: _ _ L r+�5 ane 1-11, 1F i_ _ County:
Owner Name: L nc�5p_ AuE Phone No: 9/n
Mailing Address: 1j? oe uZ AJ A/
Facility- Contact: Title: Phone No: �%�U` 5 �'y ` 5--d/ Tk
Onsite Representative: /car_ Pin P Integrator: A/1 r o
Certified Operator: I I- rw �'- a Operator Certification Number:
Location of Farm:
9-ir ine ❑ Pouttry ❑ Cattle ❑ Horse Utitude Longitude
Design Current
Swine rnnariiv Pnnnlstinn
❑ Wean to Feeder
weeder to Finish s7 1/c c?
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca ac& Population
❑ Laver I 1❑ Dairy
❑ Non -Laver ❑ Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons © ❑ Subsurface Drains Present ❑ Lagoon Area JoSpray Field Area
Bolding Ponds / Solid Trapsi❑ leo Liquid Waste Management System
Diseharaes &: Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gm/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection A; Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): i
i
05/03/01
❑ Yes [E'No
❑ Yes 9 No
❑ Yes 13 -No
❑ Yes 0-ro
❑ Yes ETiqo-
❑ Yes Ea No
❑ Yes L7rto
Structure 6
Continued

Lt
Facility Number: 22 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [�Ko
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes
(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? ❑ Yes QW -
lm98. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Elm-
9.
. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes moo"
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0140—
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes L- o
12. Crop type
9-No113. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [9-mo-
14.
4. a) Does the facility lack adequate acreage for land application? ❑ Yes [-To
b) Does the facility need a wettable acre determination? ❑ Yes [qNo
c) This facility is pended for a wettable acre determination'? ❑ Yes S<o
15. Does the receiving crop need improvement? ❑ Yes 9-5-o-
16, Is there a lack of adequate waste application equipment? ❑ Yes ['moo
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes Elmo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W PP checklists, desiiggn, maps, etc.) ElYes M -W
19. Does record keeping need improvement? (ie/ irrigation., freebo rid, waste analysis & soil smple reports) ❑ Yes [9- o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes QPio
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes [tINo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes LINO
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes �o
24. Does facility require a follow-up visit by same agency? ❑ Yes El -No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [}No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:iltty'iwbetter: explain s"atiions. {pse_additional'pages as'ri4
Copy ❑ Final Notes
Pvpe hus plans �� bLy4 hug 4e0Vj,1 kke 1G9Oor1 fb ie.o,o•re
5�nu[/ �vs�r5
ve- cp�
Reviewer/Inspector Nameurllrrwri
Reviewer/Inspector Signature:Jir{ii�j �2:el '
05/03/01
Date: 3 -
Continued

4�
Q­
-Diilisi6h,ofWater -
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ORoudne OComplaint OFollow up *Emergency Notification 00ther 0 Denied Access
Date of Visit: 03126121![13 'fin:e:
F
Facility Number 1$2 S83
. I F0 Not Operational 0 Below Threshold
Permitted N Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ......................................................... County; SAM59J) -------------------- ------------ FRO ----------
Owner Name: Phone No:
Mailing Address: (j71Jrarkcr.Memndm1JRd_ ...........................................................••- ChMoxt.-NC ......... ................................ ........ .. . Z632.8 ..............
FaciUty Contact: Liuduy.Popr .....................................Title: ---------- Phone No: .......... ...........................
Onsite Representative: Integrator:
Certified Operator: Edward.)........................ .. P.QP.t ......................................... Operator Certification Number: 191.97............................
Location of Farm:
]rake 421 N. to 1832 take left and go to Memorial Church take left on 1332 farm is 2 miles on left
—--7 -
r
N Swine EPoultry [ Cattle [ Horse Latitude 35 04 12] Longitude 0F241—
26 u
Design Current. Desigo Current DesignCurrent
Ca cit Pbpu on Pon try, io_- "�nlation Cattle,--' -�,�Capicio ',Popiiihifidiii"�L
pa�c Po
Wean to Feeder Layer ❑ Dairy
Feeder to Finish 480 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
0 Farrow to Feeder ❑ Other
.
❑
- Design Capacity to Finish Totales480
❑ Gilts
[I Boars Total SSLW 64,80
Niimber 4(114o0 us _10Subsurface Drains Present H[: Lagoon Area JE1 Spray Field Area
olding Ponds.1 Solid Traps, JE1 No Liquid Waste Management System
Discharges &Strearn 1"i acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: Ll Lagoon [] Spray Field E] Other
a. If discharge is observed, was The conveyance man-made?
b. If discharge Is observed, did it reach Water or the State? (if ycs, noti fy DWQ)
c. If discharge is observed, what is the estimated Dow in gal/min?
d. Does discharge bypass a lagoon system? (if yes. notify DWQ)
Z. Is there evidence of past discharge from any part of the operation?
❑ Yes N No
❑ Yes No
❑ Yes ❑ No
❑ Yes [] No
Yes El No
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [] Yes No
Waste Collection & Treatment
4. Is storage capacity (liteboard plus storm storage) less than adequate? [:1 Spillway El Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .--._.._...,4 .. .......... ........................ .. ........................ . ........................... ................. ...........
0/0.3/01 randnaed

;Facility Number: 82-583
Date of Inspection 02/26/2003
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application `
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Fxcessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components ofthe Certified Animal Waste Management Plan readily available?
(ie/ W UP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
, ❑ No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22..
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23,
Did Reviewer/inspcetor fail to discuss review/inspection with on-site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AW M P•? ❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to questiap #1) Explain aioy YES 'answers and/o'r airy iecommendatlon_s or anv other` scomments
Usedrawtngs of tacrhty io better eltlilain situalio�s. (use addrtianal`pages as necessary): ❑Field Copy ❑ Final Notes ;
)n -site due to notication that the lagoon at this facility had developed a leak. Mr. Pope discovered the leak and contacted Glenn Clifton
;Prestage Farms) for assistance. Mr. Clifton supervised to removal of what was later discovered to be a 1.5 inch diameter pipe that had
)een buried in the lagoon wall. Mr. Pope explained that the pipe must have been mistakenly buried during lagoon renovations that
)ccurred in 1995 or 1996. A minimal amount of the lagoon dike was disturbed during removal of the pipe- Mr. Clifton supervised the
-epair of the lagoon dike after removal.
kt the time of our arrival the lagoon had been repaired and reseeded. Vere was evidence that wastewater had previously discharged fio
he lagoon and entered waters of the state- However, there was no discharge at the lime of our inspection. No environmental impacts
Reviewer/inspector Name Pahl Sherman:.' s r d
Reviewer/Inspector Signature: Date:

Ut/U i/Ul continued
Facility Number: 82--583 Dale of Inspection 02/26/2003
Odor Issues
ere observed. Mr. Pope and Mr. Clifton were instructed to submit written notification of the events as required by the facility's
26.
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?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring, vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
'Additional mments'an r rawmgs
ere observed. Mr. Pope and Mr. Clifton were instructed to submit written notification of the events as required by the facility's
permit. It was recommended that Mr. Pope closely monitor the lagoon dike for any further seepage.

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-1� mss0. $ s .�-? 0 , .�
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r a 7 i �Q Other Agency:?IP,
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n - _,.,r. ; ; - Y�'i-,y4^�'k' ,;..Sr3Fu- h `'$i hi;y •,,;py !�p}r;.
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up ®Emergency Notification O Other ❑ Denied Access
Date of Visit: OZ/2ti12tNi3 Tim(-:
FFacility Number 82 S83
Q Not U erational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: ............ Count.: SAMEora--------•--•--------.__.--.-----. FRO__._.....
Owner Name: Ed�lutlP_oRe------------------------ ----. Phone No: 5h4 449______ -_---------------------____--
Mailing Address: Jt7.t.JrAr cr..&KcniftdalRd.............................. ............. ............ ..... Qteilulu_AC........... ............. ........... .--........... .......... 13328 ------ - - ----
Facility Contact: Lindscx.Pnpc......-.-..- -.Title: OwimC.................................... Phone No: .................-----................
Onsite Representative: ldRdSey_P!!]2>GIeDUl�llJff9A----------------•------ Integrator: P�Sfat�FsLAS-------.__-.--------------•
Certified Operator: ldtYalCtlj... ........................... P.tope........................... ................... Operator Certification Number: 19.1,Q7 ............................
Location of Farm:
Take 4211 N. to 11832 take left and go to Memorial Church take left on 1332 farm is 2 utiles on left.
IN Swine ❑Poultry El Cattle [I Horse Latitude 35 • t)4 12 " Longitude 78 • 24 26 �`
Design ;Current Design . "Current Designs Current =
Swine Ca act Po'Watton .-Poultry Capacity, Population :Cattle Ca act "''Po ulahoo
Wean to Feeder ❑ Layer [] Dairy
Feeder to Finish 480 '.: ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
"o.
C1 Farrow to Finish fTotal Design Capacity 480
Gilts
Boars Total SSLW 64,800
Nutnf>rer of Lagoiius ..` 6 - 1 Subsurface Drains Present Lagoon Area ❑ Spray Field Area
A;., t
Holding Ponds ! Sand.Traps; No Liquid Waste Management System L
Dischart<es & Stream I pacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, noti ly DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d• Does discharge bypass a lagoon system`? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part ofthe operation? ® Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure Structure 4 Structure 5 Structure b
Identifier : .....................
Freeboard (inches): 3.0 ............
dS/ll.i/!) i Cosf/iau�d

_ _. -r. --
[Facility Number: 827583
Date of Inspection 02/26/2003
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 stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? [:]Excessive Ponding ❑ PAN []Hydraulic Overload
12_ Crop type
® Yes ❑ No
❑ Yes ® No
[] Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those desig=nated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? [:]Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes ❑ No
❑ Yes ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments (refer to gnestiou #} Eii�rlatn any YES answers.gal or -any recontittentlatieas or-any;otlter.coenments ;�• ,
Use drawings of fac�hty` to better explain situa4ons:'(ase additional pages as necessary)
,. x El Field CpPY El Final Notes
r �t
On-site due to notication that the lagoon at this facility had developed a leak. Mr. Pope discovered the leak and contacted Glenn Clifton
AJ
(Prestage Fauns) for assistance. Mr. Clifton supervised to removal of what was later discovered to be a 1.5 inch diameter pipe that had
been buried in the lagoon wall. Mr. Pope explained that the pipe must have been mistakenly buried during lagoon renovations that
occurred in 1995 or 1996. A minimal amount of the lagoon dike was disturbed during removal of the pipe. Mr. Clifton supervised the
repair of the lagoon dike after removal.
At the time of our arrival the lagoon had been repaired and reseeded. There was evidence that wastewater had previously discharged fro
the lagoon and entered waters of the state. However, there was no discharge at the time of our inspection. No environmental impacts
Reviewer/Inspector Name Paul Sherman
Reviewer/Insp"tor Signature: Date:

05*110[ Continued
Facility Number: 82-583 Date oI' Inspection 02!25/2403
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? 0 Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/tempormy cover? ❑ Yes ❑ No
A ditiona! omments an or rawlnpps :� " �' �' : n° ;, � :�', � � .� # s• • a . ,�, u `�'� � � Y ��,-•.r, .� ,�
were observed. Mr. Pope and Mr. Clifton were instructed to submit written notification of the events as required by the facility's
permit. It was recommended that Mr. Pope closely monitor the lagoon dike for any further seepage.
•