090214_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Is
v'i P 6t1 • r =.`d ,.,# �1 I I,r,I� ! ,Il.r.lilY( �! It I!, I ��VFil�lll�i.l,lii; ���'Il111i1 I .�i `N4r! ii,. } -� 3!
�p!:i,�, 9,� E I !pI ( � ! � Iu ` I I I •, Division oflWatcr Resources , 3
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!!I+lity,INuml�er =�" ( �{il�j�E ll„ ,C Division of 5oil'and;Water Conservation { '
;�1i3�irir� ry;t yl,l, I,uiii�sai is .'s�`I('� r 11r, I o ��,�,'�{; Ir�i, ,I,�i,r" I,iw1. �,„i'
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Lr I rIN0 r6Y, ..,a.,( �. r tv 1 lld � �. � ��� � r,._ _ � � �.Ir ��r i ' r
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teasen for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other ( Denied Access
Date of Visit: Arrival Time: Q Departure Time: p County: h Region:
Farm Name: qc— p Owner Email:
Owner Name: U }"s `not � ly� Phone:
Mailing Address:
Physical Address:
Facility Contact: Ja.V,.,es Title: Phone:
u ?rzx_5-6-Q_Onsite Representative: _ Integrator:
LIF
Certified Operator: J�ern y 1t S0*--, Certification Number: C 0 j?; u
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
'! Design Current
�, Ctl IlsiCi , I:�„i'lo� l��'�11
rvine�, l !r•! p ty P p Ijl}�
r
�, I Poultry, r Capacity IPop , ''.,,
Cattic Capacity I'op.
t;
t Itl.
s w t ,E
ilu i�.:;9�i,
Wean to Finish
�,Wct 1
. ., �. f - - 6 4..., ,I r.IJ, 1. ,L u�T.'• '.. • - - .t {
q, - r. , I - -
I La er !j
- • ,
DairyCow
Wean to Feeder
I�iIfl Non La er
Dai Calf
Feeder to Finish
"FEE
���``,'Yf � Il� l�l {)�! ! I'I " ;
AI lr I
Dai Heifer
Farrow to Wean 2[]
„
I I�{I(II;� Design 'Current ',
��
D Cow
Farrow to Feeder}'
i ,!hh q. „ -
Po
�11�41�11�'�d!�D _.-Point t ! !��',Ca a'ci 1' �Po ' {{I ',_, =
Non -Dairy
Farrow to Finish
Gilts
Boars
�j!� Layers
u� Non -Layers
Pullets ; `'1
1J I
Beef Stocker
Beef Feeder
Beef Brood Cow
t�,Fal!Ir{
�li'itt: ��9I Turkeys l'iI. � , , -,
YI
I!
Other
urke PhUthoults
!,
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
[] NE
❑ Yes
❑ No
4S NA
❑ NE
❑ Yes
,�] No
(��
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste CQllection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Strut ure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
ONo ❑ NA ❑ NE
❑ No 01 NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
{ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
[:]NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT''
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Ap li�cation
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 Wi rift ApplilJication Outside of Approved Area
12, Crop Type(s): ` xtj I gve,95 � 7i�`t y �
13. Soil Type(s); LOB
- v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of lns ection:
24. Dia the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes go
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 14
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 9No ❑ NA ❑ NE
Other Issues .
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Rev iewerAnspector Signature:
Page 3 of 3
❑ Yes
F No
❑ NA
❑ NE
❑Yes
�jNo
❑NA
❑NE
❑ Yes
`f No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes N No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Frec6ntmendstlans or any.other; comments.
ssarv): i
Phone: Jib' 3 3V
Date: '2
21412015

0 Division of Water Quality '
Facility Number - 2�% 0 Division of Soil and Water Conservation
0 Other Agency
type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: 0 Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 0 Arrival Time: Q ' Q Departure Time: County: Ob"rh" Region: r420
Farm Name: C Owner Email:
Owner Name: S f`—i'v-M 5 Phone:
Mailing Address:
Physical Address:
r
Facility Contact: Title: Phone:
G�
Onsite Representative: Integrator: pfvs4v
Certified Operator: Ko i 5X14 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La cr
Non -Layer
ury rouitry
Layers
Non -Layers
Pullets
Turkel
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Y, No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
[DNA ❑ NE
1P NA ❑ NE
VNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: 0
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
P 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
[P 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
�3 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
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ,q No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 C rp W'ndow ❑ ide fC11'❑ ApplicationOutside of Approved Area
PYP12. Cro T e(s):r_G��� V+
13. Soil Type(s): L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes PNo
❑ Yes MNo
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:1 Waste Analysis [] Soil Analysis [3 Waste Tr sfers ❑ 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 MNo ❑ NA ❑ NE
T
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
rM No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[n No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1p 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
[P No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONO ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No ❑ NA NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t!p mow_; 3 V
Date: 9/.5
21412011

f� , _1q 9 Division of Water Resources
11 Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: l♦ Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ' , County: 1, Region:
Farm Name: tOwner Email:
Owner Name: FtIYYW-S' Phone:
Mailing Address:
Physical Address:
Facility Contact: jaws Title: Phone:
Onsite Representative: u 1 Integrator:
Certified Operator: J;4)ew I?f �som Certification Number:
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
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
ivunmu!
Pullets
Other
Poults
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No R NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
� NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes [:]No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes A] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes Z3 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDate of insection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 4 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes]
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Fp No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E[ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: 111-,1,411,5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 18 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rp No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Pg No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [�t No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.'
Use drawings of facility to better explain situations (use additional pages as -necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ( z
21412014

Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: t& Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f I Arrival Time: D2-7-c Departure Time: County: )? LAO Region: F;0_0
Farm Name: P—) C Owner Email:
Owner Name: -- 92t-es iq5`e was G, Phone:
Mailing Address:
Physical Address: 1
Facility Contact: '50-i"s Title: Phone:
Onsite Representative:
i
Certified Operator: JG''ern �a�rhsori
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator: -Pr-es&z e
Certification Number: t? 75�b
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Non-L
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop,
DaiEy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
[-]Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes No
[:]Yes No
® NA ❑ NE
[] NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑No �gNA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
F
❑ 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
pa
❑ 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
[a No
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M 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
E] 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 Z No ❑ 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 Acceptablee Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): GzY am r ., 6�,$$ �QS��, St., lr- aw,�
❑ NE
13. Soil Type(s): La 6
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 [�j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �B No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Pa 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 [ 3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [?n 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 21412011 Continued

Facili Number: -20=Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑—Yes [� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[j No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E No
❑ NA
❑ NE
33. Did the ReviewerlInspector 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 2 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain.situations-(use.. additional -pages as' necessary).,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �1 J
21412011

r �zj-40)
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y Arrival Time: ! OQ..., Departure Time: , .0 County:
Farm Name: - I �� Owner Email:
Owner Name:} {e C.,� �&(ff rs Inc. Phone:
Mailing Address:
Physical Address:
Facility Contact: Lamb Title:
Onsite Representative: IRmb
Certified Operator: t��iv^�-�-•. -�3E�
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
Other
Other
Latitude:
Region:
Phone:
Integrator: ?fe_d1aS42_
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Poults
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Pry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 8 No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes
❑ No
" NA
❑ NE
❑Yes
No
[3 NA
❑NE
❑ Yes
Eg No
❑ NA
❑ NE
Page l of 3 21412014 Continued

lFacifity Number: Li- Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 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
[E� 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 off Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L7 rC�.s S C tur/�►'Y1 %G� ((1
0-�e(s:J
13. Soil Type(s): LA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P 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 [D No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ©No ❑ NA ❑ NE
the appropriate box.
❑WUP [I 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 9 - c2l 4 FD-ateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �a No ❑ NA ❑ NE
33. Did the Reviewer/Inspcctor fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ®No ❑ NA ❑ NE
Comments (refer to question:#): Explain any YES answers and/or any additional recommendations or,,any other comments . ,
Use drawings of facility to" better explain situations (use addltional:pages as necessary)
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
Phone: gf"'53--53W
Date: 14f fiq
2/4 OM

w uivision of warer tluanry
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: •0 Departure Time: Q County:
Farm Name: 12-14 C Owner Email:
Owner Name: Tra—ko5.G.I Phone:
Mailing Address:
Physical Address:
Facility Contact: Q Title:
Onsite Representative: V C. ml e_s
Certified Operator: Je.(en' :, IOL msod
Phone:
Certification Number:
Region: '�
Integrator:
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Poults
Design Current
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
DaiEZ Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
E] Yes
[ A No
❑ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
n NA
❑ NE
❑ Yes ❑ No
Yes No
❑ Yes ® No
/ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3 21412011 Continued

t
Facilit Number: q - jDate of Inspection-
Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[,3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
;2 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes Qg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes K] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift
❑ Application Outside of Approved Area
7W,inndd
12. Crop Type(s): �51 LZ/�1rY 41dPj �SS' 9 i U+t�
1 Srn, G_r4, _
13. Soil Type(s): LAB
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
RRe uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: ZF - Date of Inspection: 2 !Z
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 to provide documentation of an actively certified operator in charge? ❑ Yes (1 No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 7� 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M9 No
LP
❑ 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
[P No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
' No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
lC.omments.(refer to question #),Explain any YES ,answer&nnd/or any additional_ reeommendations or;any other 6F'n'J ents
ifsedrawingbeteexplainsituations (useadditonf l pages;:as=necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910 -. 33-3.300
Date: e712$f Iz
21412011

r-Azos ' o illc,
. G1.Eten DIVISION OF ENVIRONMEN'PAL MANAGEMENT
� 1 November 4, 1994
� wt
SUBJECT: Compliance Inspection
t3 County
Dear :
on inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this .facility is in compliance with 15A NCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
Enclosure
cc: Facility Compliance Group

NORTH CAROLINA DEPARTMEla OF zwmamma, HEALTH & NATURAL RESOURCES
DIVISION OF F.NVIROMENTAL MANAGF.lCMT
Fayetteville Regional Office
i
L
Animal Operation Compliance Inspection Form
....... ' �?ACrLITY TE�EP�ioriE � ;• .: .
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
imal Operation Tyre:
A Horses, cattle, wine poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANZMLL
WASTE MANAGZKENT PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
b. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
un
11
no=
on
F. W�'
y1

SECTION III
1 Y I NJ COMMENTS
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage L/
an which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7, Does animal waste lagoon have sufficient
freeboard? How much? (Approximately (A 6�, -)
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION Ty
Comments
� At 44
� u�•1 / 07
1V41*

Division of Water Quality
Facility Number - EM O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency0 Other O Denied Access
Date of Visit: .r Arrival Time: Departure Time: County:
Farm Name: _P7,14 C Owner Email:
Owner Name: !LS i►l Phone:
Mailing Address:
Physical Address:
Region: 'O
Facility Contact: Title: Phone:
Onsite Representative: O_nj c' integrator: T—re.S6L
Certified Operator: -IMF �ry.�►-r Certification Number: gW75V
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean Z
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Pul
Other
Poults
Design Current
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
DaintCalf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E� No ❑ NA ❑ NE
[:]Yes [:]No NA ❑ NE
[:]Yes ❑ No NA ❑ NE
❑ Yes ❑ No M NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: OF -I Date of Inspection:
r.
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 03NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): k
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q� No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P 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 R No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rM No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q@,No r] NA ❑ NE
❑ Excessive Pending ❑ 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 [[ � 6k"❑ Eviddence of Wind Drift ❑ Applicatioon Outtside of Approved Area
12. Crop Type(s): �'s4d wlunlLl C'XW+ l}+'`+ VL1P i�2�PryY
13. Soil Type(s): I1aF7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes X No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® 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 Iand application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
[3 Yes PNo ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes `�No
❑ 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 T No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility ?slumber: q - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q9 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 � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[]Yes
P 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
E� No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ g No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or -any other=commentsgi �Aii
Use drawings of facility to better explain situations (use additional paces as necessary).���
`.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]�
Date: E-M 41
21412011

Division of Water Quality
Facility Number i O Division of Soil and Water Conservation
- - o Other Agency
Date of Visit: 0 Arrival Time: Departure Time: r County: Region:
Farm Name: MCI Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: jj G. 4___ Title:
Onsite Representative:���S
Certified Operator:evri io11'l�y?
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other_ --
�o
Latitude:
Phone No:
Integrator: 1T1rg4_
Operator Certification Number: qg !,gn
Back-up Certification Number:
6
Design Current Design Current
Capacity .Population Wet Poultry Capacity Population
--� ❑ Layer
I I ❑ Non -Layer I I I
Dry Poultry
❑ Layers
❑ Non -La ers
❑ 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?
Longitude: = o =' =
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 ZPNo ❑ NA ❑ NE
❑ Yes ❑ No KbNA ❑ NE
❑ Yes ❑ No [ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
El Yes LpNo ❑ NA ❑ NE
❑ Yes 9) No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 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?
Struct�e I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ONA ❑ NE
Structure 5 Structure 6
❑ Yes [�'No ❑ NA ❑ NE
❑ Yes [FNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes FpNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ' No ❑ NA El NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 AcceptableCropCrro_p Window ❑ Evidencee,!o�f,Wind Drift ❑^ Application
lOutside of Area
12. Crop type(s) �'rIT2.[_ AVI"L 6u �5 6;s e_), J 19'+r �h
13. Soil type(s) L08
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1�2 No
❑ NA
❑ NE
er�t : �k a ..aA�Y'fi +@"� 7.*r� -` A.
Comments (refer to question,#) Explain any YI✓S answers and/or anykrecommendations aaany other'comments: '
t.¢ ;�i' _. l ki V i p §•� k�'�' •�vs�C.' ,,{Ya�.ek�
lJse drawingstoffac�lity to better explain srtuations (uselatlditlarial pages asnecessa , ,
�e�e�,a; .��� ���� �3"�.���`,.i � s��.�: + � �'' a �'..�`��-:r�'
c12-7
Reviewer/inspector NameaN� �§ Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

.� ti
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [--]Yes ;a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 59 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No P NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
'❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional 6nalments, it, /os,Drawings sa's , ;;+„ , r`ag=# T I — -2.
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint C) Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I - f/.�/ 0 ! I Arrival Time: Departure Time: �� County: FL"k-ri
Farm Name: T —4 C_ Owner Email:
Owner Nnme! RY_ � i&M S -�:R,Lr Phone:
Mailing Address:
Physical Address:
Facility Contact: ' �'"I Title:
Onsite Representative: ��4
Certified Operator: ecem ' 06 n
Back-up Operator:
Location of Farm:
Region: AU
Phone No:
Integrator _ ,,,,,•
Operator Certification Number: 7-5-0
Back-up Certification Number:
Latitude: ❑ o = i Longitude: ❑ o = , =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet PuuIIyy Capacity Population
Cattle C*apacity Population
❑ Wean to Finish
❑ Layer I I
❑ Dairy Cow
❑ Wean to Feeder 1
10 Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy -Heifer
Farrow to Wean ADM ,T
Dry Poultry
❑ DEZ Cow
El Farrow to Feeder
El Layers
ElNon-Dairy
❑ Farrow to Finish
ElBeef Stacker
❑ Gilts
ers
❑ Non -Layers
El Beef Feeder
El Boars
❑ Pullets
❑Beef Broad Cow
❑ Turke s
Other
❑ Other I
❑ Turke Poults
JEEJ Other I
umber of Structures:
Discharges & Stream Impacts
l . 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 r No ❑ NA ❑ NE
❑ Yes
❑ No
1;@ NA
❑ NE
❑ Yes
❑ No
Qa NA
❑ NE
❑ Yes
❑ No
WNA
❑ NE
❑ Yes
No
ElNA
[INE
ElYes
w
No
❑ NA
❑ NE
12128104 Continued

v
•
Facility Number: — Date of I nspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes rNo A ❑ NE
Structure I Stnicture 2 Structure 3 Structure 4 Structure 5 't5 ructure 0
Identifier: 1
Spillway?:
L)esigned 1'reehoard (in):
Observed Freeboard (in): if
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes (3No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ?No ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Ai)o ication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 62<o
maintenance/improvement? ,,..,
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2<o
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into 13are Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of nd Drift �❑ Application Outside of Area
12. Crop type(s) �s W RjP,,,c6 � � <;K • Q,1
13. Soil type(s) irLL�Le
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
Off'NNo
I/ No
l�
,/No�No
2No
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: 3 LO�
l Z/ZB104 Confinued

Ina
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ewo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IVo ❑ 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
2<
❑ 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
Eo
El NA
El NE
23.
If'selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`?
[I Yes
E3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,(�✓,/No
iJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
eNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
eNo
❑ 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
FNo
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[✓] No
❑ NA
❑ NE
r :., 'i ;. P. as ,g �„ .� � A � �' It � � 1 ;;�
AddAional;Comments and/or Drawings I x €t°? '�.: `:' x.' . fir,....... .' Y" 11''4 '41 "- ^�:....
Page 3 of 3 12128104

V Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
Other Agency
Type of Vlsit 4D Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ? 00) Arrival Time: I _ Departure Time: County: A_0F4
Farm Name:--7�r-_ - -- --- - - - - - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: + Title: Phone No:
Onsite Representative: f Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
` Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region: 1Z0
Latitude: = c = 1 = Longitude: = ° = 6 0
Design Current ' Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑Non -La er
Discharges & Stream ImRaets
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
El]
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: _�d..
1..Is any discharge observed from any part of the operation?
❑ Yes
;§No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1PNA
❑ 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
P
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JR No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

J �►
Facility Number: Date of Inspection ' 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No VTNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes AA ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window `` [I Evidence vi�idence of Wind Drift ❑ Application Outside
o,,f, Area
12. Crop type(s) �S f. hz [7'�'�SS 6p�' j sryt - �r, 'gar �
13. Soil type(s)
Y
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IpNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�bNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
T No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
p
❑ NA
❑ NE
Reviewer/inspector Name °; Phone: 33`3.0
Reviewer/inspector Signature: Date: oZ�
Page 2 of 3 12128104 Continued

Facility Number: (.fi — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JpNo ❑ 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 U�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[4 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JP No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
`P'' 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
1%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
[ANo
❑ 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
JP No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water. Quality
Facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 91 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 19_j Arrival Time: eparture Time:.County:
Farm Name: ._ P �_ Owner Email:
Owner Name: Phone:ky
_
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
hone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 c = ` = " Longitude: ❑ ° = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current,
Capacity. Population.:;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: T
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?
m
N
❑ Yes [UNo ElNA ElNE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
1� NA
❑ NE
❑ Yes
❑ No
❑ Yes
TNo
❑ NA
❑ NE
❑ Yes
b No
❑ NA
❑ NE
12128104 Continued

Facility Number: CRa Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
St Nc
re 1 Structure 2 Structure 3 Structure 4 Structure 5 S ructure 6
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in): 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1P No El NA [I NE
(ie/ large trees, severe erosion, seepage, etc.) l
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes q5No ❑ 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA [INE
maintenance or improvement? L
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (� No ❑ NA ElNE
maintenance/improvement? '1
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) L`� y U
13.
Soil type(s) �?
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I�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
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/[ nspector Name Q, i s f Ce Phone: 33 W
Reviewer/Inspector Signature: Date:,
12128104 Continued

Facility Number: Date of Inspection 111�A j�
Re uired Records & Documents j
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No El NA ❑ NE
[I Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TransfersI:IAnnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
--MNo
❑ 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?
l
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
( No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Eallo
❑ 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
Ca
❑ NA
[I NE
12128104

tO Division of Water Quality 'F
FaCllity'Nlltnber O Division of Soil and Water Conservation}
�.
_.._ ._
n.-Other Agency .V
Type of Visit 'WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &I outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 3_ '00 e-. County:
Farm Name: Lf�_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No: _
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current.
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean SAX)
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts +I
❑ Boars
vrner .
❑ Other
Region: A`-"-'
Back-up Certification Number:
Latitude: = e = 1 = Longitude: = ° = '
Design. Current
.Wet Poultry. Capacity' Population
❑ Layer
I
❑ Non -Layer
'Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Desi`n, Cur
Cattle Capacity, i'apul
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
i
❑
Beef Feeder
❑
Beef Brood Co;[
Number of Structures ,
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
[B No
❑ NA
❑ NE
❑ Yes
[)j No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
(� No
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
12128104 Continued

acilO Number: —21 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?
Struou re„ l Structure 2 Structure 3 Structure 4
Identifier: t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�r
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ITNo ❑ NA ❑ NE
❑ Yes ❑ No ip NA Cl NE
Structure 5 Structure 6
❑ Yes [59 No ❑ NA ❑ NE
❑ Yes t No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA Cl NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) U Q - ! v
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ 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
0j No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
"® No
❑ NA
❑ NE
Comments (refer to question #):.Explain any YESanswersand/or any recommendations or any othercomments
Use drawings of facility to better explain situations. (use additional pagesas`necessary):
:_�:
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12128104 Continued
..S. —J ,

y Facility Number: 0 Date of Inspection l
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J!PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes d�j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
5�No
❑ NA
❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
kNo
❑ NA
❑ NE
26, Did the facility fail to have an actively certified operator in charge? ❑ Yes JEJ No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
R No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
UONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
i,,
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
q[No
Dd No
❑ NA
❑ NE
Additional Comments and/or Drawings;
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y/-�.S/"j/� Arrival Time: �3C Departure Time: County: ddlaa&A,* Region: ��d
Farm Name: / Iy C Owner Email:
Owner Name: Pr r-_C44 19 dt- Phone:
Mailing Address: _ �f• d ,_ d oy y 3 '8 ...,9 ,..� r_M6AJ
Physical Address:
Facility Contact: Title:
Onsite Representative: 1
Certified Operator: � Ra b 1 ti n
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: P 4s-�-���
Operator Certification Number:
Back-up Certification Number:
Latitude: [ a [ [= Longitude: = ° = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
.I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
El-Daity Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: — ,� j Date of Inspection
-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 , Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): -:.. 19
Observed Freeboard (in): ' a q N
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [k No ❑ NA ❑ NE
❑Yes ®No ❑NA [I NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CQ 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 FX1 No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,aCP.0"at cG41 h C A 5 (s
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ® No ❑ NA ❑ NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: j 11 Date of Inspection
required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [U No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ® Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes © No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
© No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
. ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[B No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
51 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
©No
❑ NA
❑ NE
Wditlgnal Comments and/or.Drawings:
o2 - ae.e.. 4_ traih c� a.; c t r. i
A. 'L' fot3r'-,%}.i-Cad tl s4Gfw r..wa-4- t%ave 6 o wwl g gLkq It
12128104

Facility Number Date of Visit: � Time: ' a
Q Not Operational Q Below Threshold .
jf ernnitted 0"C"ertfied 13 Conditionally Certified 0 Registered Date Last Operated or A/bove Threshold: --- _—•
FarmName: ... _...._» ....._� I..� ...__...... ».._.. _......._......__.... County: .» dJ.�.�l.C.ex......»».......
Owner Name: Pr!!�sw»......»..r4i ... ........».. Phone No: ... »....
Mailing Address: ... �:. Q , .. 6Gi ...... JA........... _............»»..».»........»................
Facility Contact: _ I 1 &1►»ii!._ . .+R7.Q L G.'an+ �. »_. Title:._.._. __._ . - -- ..... _�___. Phone No:
Onsite Representative:C/Ic _ „ , . !Bai�?`anf _ _ .,. , ._» _ .. Integrator -
Certified Operator: ,.. _._... SC.C�f.»... ».... .�fJ :.��iJ..»....».....»» »..»........ Operator Certification
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • < 0L° Longitude • 6 44
-Design Current sR a s t i w � '` Cilrrent , '� DessgII � x SCairrent ,
Swineei`Po`nlatton`: Catfe . Cas ace rPo alation .s;
❑ Wean to Feeder .❑ Dairy f
❑ Feeder to Finish ryy Non -Dairy
r1
arrow to Wean ) 1
❑ Farrow to Feeder Other a �'
Farrow to Finish �t ,` ,
/'��'' r Totai�Dt gn �:a'FORY
\,Ti1tJ .As�t ,�1
Boars INS: '_ _ tt' ' Total SSLW f
. ...-.. .. ..?:Mfg .d.�_....
rNll�err Off' ^AbOQQ11S ��� � zk w;r�� �'e
❑ Layer
❑ Non -Layer
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 21 fo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [�o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes M-Xo
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 UXo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes B 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 �❑�lGo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: »»........ �.................... __..._ __.____ ....»........_._
Freeboard (inches): qe>
12112103 Continued

Facility Number: q
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [J'Ro
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 21K01
Air Quality representative immediately.
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I3 £ - SWG['!4° i&dfan ,i�i:O�tioils or 8ft `At E3;C�3 CIIt8. £s gt' i4 t2'�; 3 1 Ej
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7se;dsav n Eof to bestir i sibnat�sms.E a §3 u[;6t€a i,�6€�.. Pa� 1ssa6 ��r€eE€ [ yy#4. > x°sgs�a; ni€ £ u�.,g . >p �.:"•;,, iiiir b "e,_a mr i.,.�>, 8 r €.> t i A� s.1, it,3 0-.E � i¢aisktll+ani il?t•< ,s .�i#:.� h.°: _# :6 s �> .�a eld Copy
Final NO -EA?'
. e.nTY i;
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i
Recsrrls ore �:a' d 11. 30Y)�
p ; 'I`j" a ; is ,,ty € ryE , :[i¢ i ',ae r¢pr n °q E s e $ a F " g ^", s a ".
F" / �& r 3 E 1i ��" k �6 it i �A f� Y �a'k p6�'g. &y d� H
Reviewer/Inspector Name / 3€° " ea' ';sl:�', :.i £ aEa�& ' ` .�� �- �"
G a L--,ia_R� , 4 8 t , �e§r`4u £« ad�.i— r.-. 7� sk �, a..,,.-.k.-th..3iz 5
Reviewer/inspector Signature: Date: 42 u
Date of Inspection .p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes
EfRo
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?
❑ Yes
©-lZo-
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
2<o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ yes
Mo
elevation markings?
Waste A lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
131�0
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
L o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Qsrin_V_e4__OrMd_,Sn:A // Q Q /A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
94<0
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
[9-go
16. Is there a lack of adequate waste application equipment?
❑ Yes
[1To

Facility Number: dj -- /'' Date of Inspection 1? 3 o Y
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes
❑ Yes 0RI10,
❑ Yes 2<0
❑ Yes Olgo
❑ Yes 2<0
❑ Yes [�io
❑ Yes 21Z
❑ Yes C3'Rb
❑ Yes [1To
p-Yes ❑ No
❑ Yes O'Ro
❑ Yes [3Vo
❑ Yes [pro
❑ Yes [g-lao
❑ Yes [BrNo
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103