630008_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Diffi1o` n f Water Resources
Facility Number ®- I b l O Division of Soll and Water Conservation
Q it Agency Igo
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: MO&Q Region:(Ce?0
Farm Name: �( Q,^ �� �!S �,�,y ��,, Owner Email:
Owner Name: _ / L`U— �Lc.--n� Phone:
Mailing Address:
Physical Address:
Facility Contact: �d ``] %�6t?'� Title:
Onsite Representative:
.yi
Certified Operator: G1_4 i� J+ f S k
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: N� �!�✓[�
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capaclty Pop.
Wet Poultry
Capacity
Pop,
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
12 s"Z>
Dr P,oultr
Ca acit
P.o
Non -Dairy
Farrow to Finish
Layers
I 113cef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Puults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
IN No
❑ NA
❑ NE
of the State other than from a discharge?
Page I o. f 3 21412015 Continued

Fa cility Number: -5Z Date of Inspection: �(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
U ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J Z,
Spillway?:
Designed Freeboard (in):
Observed freeboard (in): C ! ( L
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 ofAcceptable, Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Tme(s): t ZaGVkk (n,�S jya, 4 5V;0
13. Soil Type(s): /�f_ P) i VrX.
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
FZ No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ep 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 r79. 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: G Date of inspection: Y I
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 ff 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes E� No ❑ NA ❑ NE
❑ Yes 5No ❑ NA ❑ NE
❑ Yes
(] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[IDNo
❑ NA
❑ NE
Phone:q t a—{.33 --73,K:,
Date:
21412015

Type of Visit: ® Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: S Routine O Complaint O Follow-up O Referral Q Emergency C) Other 0 Denied Access
Date of Visit: Arrival
�Time: O " Departure Time: ,' pa— County:
Farm Name: ,trQ �� � L/fjs flay_)._ Owner Email:
P
Owner Name: L�"r�f �✓1`-+ S CLL. -, Phone:
Mailing Address:
Physical Address:
Facility Contact: Alovp Title:
Onsite Representative: N y
f
Certified Operator: wir SU h
Sack -up Operator:
Location of Farm:
Latitude:
Region: 490
Phone:
Integrator: 4z�-
Certification Number:
Certification Number:
Longitude:
Swine
Design Current Design Current Design Curent",
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pap
4
Wean to Finish
Layer
Dai Cow
('
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Deslgn Current
D . P.oult . Ca aci P.a
Dai Heifer
Farrow to Wean
arrow to Feeder
Zap
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
ITurkey Poults
Other
OtherI
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [� NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? 11
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 -�n No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes �p No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

tFacilit-�Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Pg NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 T-7- T
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes IV?
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 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 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �+ ❑ Evidence of Wind Drift
,,�� }} ❑ Application Outside of Approved Area
l �,STr
12. Crop Type(s): L r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[U 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
P No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Reouired 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.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EP 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
DNA ❑NE
Page 2 of 3 21412015 Continuer!

Facili Number: Date of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Qd)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
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative`?
34. Does the facility require a follow-up visit by the same agency`?
[:]Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�q No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
ICominents,(refer, to question #) Expl sin! any YES :.unswers and/er any additional recommend ationspr any other comments. - II
Use`dr.:a'wings-of facilit. to;better:ex bIa1n9.situations1!.(6se additlonai:psues as necessary): I
Reviewer/Inspector Name: bm NUIP Phone: q/0 "fit '3_�'W
Reviewer/Inspector Signature: 444"Date: ato
Page 3 of 3 21412015

• Division of Water Resources '
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ® Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! B� Departure Time: County: Xl�R­ Region: _
Farm Name: �X `� �t.� �.��„ Owner Email:
Owner Name: eyw i� Phone:
r -
Mailing Address:
Physical Address:
Facility Contact: jj5522=4 Title: Phone:
�f
Onsite Representative: r Integrator:
(►� ~ ; i) f
Certified Operator: 1-46L4CI�`�" t �^ 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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La cr
Non -La er
Dry Poultry
Layers _—
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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 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
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑Yes
❑No
[�jNA
❑NE
❑ Yes ❑ No
❑ Yes No
[—]Yes ® No
® NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: jDate of Inspection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�5 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: _� Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[M 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
QyNo
❑ 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
[P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ep 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?
T
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
[n No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
0 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
Renuired 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 ® No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [q No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Q1 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [�] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes %{P No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes (] No ❑ NA ❑ NE
❑ Yes j�71 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [jq No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[]Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: +' �"�"!� Date; rP
Page 3 of 3 21412014

(Type of Visit: 0 Compliance Inspection U Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access fI
Date of Visit: Arrival Time: '.00 Departure Time: Sao County: i WAP_ Region:
Farm Name: „ZAta ti _S Owner Email:
Owner Name: — PLt"rV13 Phone:
Mailing Address:
Physical Address:
Facility Contact: IZK, n IpDr Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Bach -up Operator:
Location of Farm:
Latitude:
Certification Number: 197041
Certification Number:
Longitude:
Design Current
Design
G' r:.rent
Design
Current
Swine Capacity G.
Wet Poultry
Capacity
mPop,
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairyfleifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
O
2,$0
D , P.oultr.
Ca aci
I'o P.
Non -Dairy
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[�j NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

jFacilisy Number: (aj - 75 Date of Inspection: g'fU/ZA-
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 �iNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z'
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 O No
❑ NA
❑ NE
9. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E�j No
❑ NA
❑ NE
(not applicable to roofcd 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 fig No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): '_ @ 0& - Ly" g $ i&. VW_4,
--
13. Soil Type(s):
14. Do the receiving crops giffer f om 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
QD 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
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E':a 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 E� 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 E�g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili 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
P No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[5 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
Z) No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ 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.
D Yes
QD 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 7 ] 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.
i. Ilse drawings of,facillty to better explain situttiaris (use adsiitianal pates as necessary).
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: t6--` 33-33W
Date: e Lo-� 'e
21412014

I, !_'A
e u Division of Water Quality
Facility Number - 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
2eason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: Arrival Time: IP
fr` WZ_ Departure Time: t ra0 , County:
Farm Name:— IUMIZf,
\a t4i//�s r"w WN Owner Email:
Owner Name: r P,� i 5 Phone:
Mailing Address:
Physical Address:
Facility Contact:L,., f�Pfif Title:
Onsite Representative:
I
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
�CAFarrow
to Feeder
%ZS0
17,5;D
Farrow to Finish
Gilts
Boars
Other
Latitude:
Phone:
Integrator: /f (j �wf✓
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
ury routtry U
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees 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:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf'
Dairy Heifer
DEXCow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes ❑ No
NA ❑ NE
�NA ❑NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
IT No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Vacili 'Number: Date of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Y] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
fp NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Lr it t
Observed Freeboard (in): r ! �J.(`:f!_
5. Are there any immediate threats to the integrity of any of the structures observed`?
❑ Yes
[P No
0 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
R 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
1p
❑ 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
EDNo
❑ NA
❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[j4] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F 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 ❑ idence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):��f
13. Soil Type(s):
14. Do the receiving crops differ.Km those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[]o No
❑ NA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
T
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
FNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[] No
❑ NA ❑ NE
Page 2 of 3
214120II Continued

facili *Number: Date of Ins ection:
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 ;g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �1P No ❑ NA ❑ NE
Other Issues
29, 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 0 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes T � 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 comments7771
Use drawin s_of facility
- t.t
g.ta better explaitn`situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: LP-y3 3r 33�
Date; L2,q
21412011

• Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: (♦ Compliance Inspection U Operation Review U Structure Evaluation U 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: 2.' Departure Time: O �`L� County: /i m4p- Region:
Farm Name: ��I L�� t I, s h� Owner Email:
Owner Name: Nt �. t/J �►� t ,�, Gr Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
�T
Onsite Representative:
Certified Operator:
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
u
Latitude:
Phone:
Integrator: AA!�r L'-L"&
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Nan -La er
Non-L
Pullets
Other
Puults
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:
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ NA ❑ NE
❑ Yes []No ip.
NA ❑ NE
❑ Yes ❑ No MNA ❑ NE
❑ Yes ❑ No , 3 NA ❑ NE
❑ Yes Uq No ❑ NA ❑ NE
❑ Yes I No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes Qj No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes El No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Struc re 6
Identifier: 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1214 2q
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.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
9. 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? 'T
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 ElFleavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):".t r3✓W­,r4 6;A4S A)] ��
13. Soil Type(s): oqe�
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 _1� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes-�a No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [!►No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

4- 7
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 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes No ❑ NA
❑ NE
Comments(refer to question #): Explain any YES answers and/or any additional recommendations or any other.. comments.-
wings of facili to better, explain situations (tree additional pages:as necessary).
Reviewer/inspector Name: r_V "'f"
Phone:
ReviewerAnspector Signature; A"40
Date: �I
Page 3 of 3 .,
21412011

Type of Visit: 0 Compliance Inspection Q Operation Review O Structure Evaluation Q 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: Departure Time: /.' County: �� Region: I
1 I /
Farm Name: Owner Email:
Owner Name: [ V i� �U''"f�NMS ( Phone:
Mailing Address:
Physical Address:
Facility Contact: O Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator: N6— 0"
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
"Ho
_. Ax �E
Destgn Current
Design Current
Capaci
W,etYPY��oulti yapaSiMmm: 'tGp k k �I'I �i�64N a �,d SJ An 5, rA 4 � A, ".'� . L f �,' I�J�
Laver
Non -Layer
,k'�'I'I ii�'
If
Finish
Feeder
o Finish
rFeeder
DairyCow
DairyCalf
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr P.oultr Ga acit P-O .
Non -Dairy
Farrow to Finish
Gilts
Boars
Layers 9
Non -Layers
Pullets
Turke s .
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge From any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No PNA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued ,

Facili Number: - Date of Inspection:
Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
O�3 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rp 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
[�j 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
J�] 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 ❑ Fleavy 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 vidence of Wind Drift ❑ Application Outside of Approved
Area
12.Cro e(s): SeS 40
P TYp
13. Soil Type(s);
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
W1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes`
No
1P
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[l Yes
T No
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
[5 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[5 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:
2 L Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes �j 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 [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes %Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j No ❑ NA ❑ NE
T
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 'M 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 t�l 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:
❑ Yes Vt_�nj No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[]Yes tp No
❑ NA ❑ NE
❑ NA ❑ NE
❑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 T No [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Coirimedts (refer to question #): Explain any YES answers and/or any additional recommendations or any.other. comments:
Use di awinei:of facility to better explain situations (use additional paces as necessar_y). t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �7 �!'
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 41 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Q2` O Departure Time: 0 County: M Region:
Farm Name:.L
_ "1A CL CA �,y
l :5 a2rJjj Owner Email:
Owner Name: P(.(,fy/j C /►1S "Ti, C' Phone:
Mailing Address:
Physical Address:
Facility Contact: _qK t1 Mftrf Title:
Onsite Representative: "I
Certified Operator: Aj -Q
Back-up Operator:
Location of Farm:
Latitude:
Phone:
l
Integrator: Nk (.r.r✓IS
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish JLayer I
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
(2,SV
Dr. P,oultr: Ca aci Po
Non -Dairy
Farrow to Finish
Layers
i
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Puults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PZNo
']�
❑ NA
[] NE
Discharge originated at: [3 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[�NA
❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
❑ Yes
No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes,!notify, DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

acili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[P No
[DNA
❑ 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:_ Z
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): j
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
[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
$ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
� No
[DNA
❑ 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
?ay-yvu.l "S Ti
12. Crop Type(s): cL e
13. Soil Type(s): Ae91 VZI/ ,
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EP 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
j J No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ef No
TT""
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
� No
❑ NA
[3NE
the appropriate box.
T
❑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 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 Z
No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

aclfl Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
D Yes
[ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
CPI No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
f No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
34. Does the facility require a follow-up visit by the same agency'?
to question #): Explain any YES answers and/or any additional reco
acility to better explain situations (use additional pages as necessary,
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes FM No ❑ NA ❑ NE
❑ Yes 49 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
g�l No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
wattons or any-otne
Phone: "► I Q -33 3a?
Date:
21412011

J
(Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance ]RI
eason for Visit Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other [IDenied Access
Date of visit: Z5 O Arrivall'I'ime: Departure'1'ime: �/L'o0 County: Region: 4©_
Farm Name:
Owner Email:
Owner Name: NG✓1 a�4YVM 4 Phone:
Mailing Address:
Physical Address:
Facility Contact: —jP11. 11r1QVf-'C_ Title: Phone No:
Onsite Representative: U Integrator: I" A&Y-✓t -S
Certified Operator: 'e Operator Certification Number: l oo0
Back-up Operator:
Rack -up Certification Number:
Location of Farm: Latitude: E�j o =' = Longitude: =" =' [= "
DiCurrent
DesignCurrenine
Capapulation
Ai
wet Poultry Capty
Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑Dai r Cnw
❑ Wean to Feeder
❑ Non -Layer
iry Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Da Cow
19 Farrow to Feeder
t126b
El
El La ers
Farrow to Finish
❑ Non -Layers.
❑ Beef Stocker
ElEl
❑ Giits
❑ Beef Feeder
❑ Boars
❑ Pullets
ID Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
P 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
[P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
6 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ N E
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. 1s 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
J�g NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
1P 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
® 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
1� No
❑ NA
❑ NE
8. Do any of the stuetures 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 8 No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) lX.f" 6Z-4 fs f & P
13. Soil type(s)
1 . , /
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
lNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ep 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 #1): Explain'any-YES answers addlor any recommendations or any other comments.
Zs'Odrawings of facility to. better; explain situations; (use.additional,pagesas necessary):
7
Reviewer/Inspector Name;Phone: 33Qp
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1�No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �5 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 YNo ❑ NA [__1 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
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
A] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
[No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
(v
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector bail 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
Cl NA
❑ NE
AdilifianafComments'und/picDrawings.:
w
Page 3 of 3 12128104

r
WDivision of Water Quality
Facility Number ( 0 Division of Soil and Water Conservation
0 Uther Agency
Type of Visit '0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I y
Arrival Time:
Departure Time:
County:
Farm Name: ! YLC I aitll
7 l ` 1-5
1�M
Owner Email:
Owner Name: 1\ C-1 P Ulm V ! 5 l-10-ir iS r h C-1 Phone:
Mailing Address:
Physical Address:
Facility Contact: (IN r i 1 cc r, 'Title:
O {
Onsite Representative: yl W 1' co r C_
Certified Operator: rw_
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
Region:
Phone No• l /0 , eG57'70 /,5�
Integrator: pw- w 1,5
Operator Certification Number: r S36
Back-up Certification Number:
Latitude: = =I = Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
tI ❑ La er
I ❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. 1s any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Coyd
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M.
d. Does discharge bypass the waste management system? (Ifyes, 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?
El Yes )MNo ❑NA ❑NE
❑ Yes
❑ No
�4 NA
❑ NE
❑ Yes
❑ No
JONA
❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
J� No
❑ NA
❑ NE
12128104 Continued

Facility Number: 6 3 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I Z
Spillway?:
Designed Freeboard (in): 2 G
Observed Freeboard (in): .ZA-) U
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 No
ElYes 4No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
15.Yes14No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ""Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes XNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PKLNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes kNo ❑ NA ❑ NE
❑ Excessive Pond ing ❑ 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 Crops Window ❑ Evidence of Wind Drifl [I Application Outside of Area
12. Crop type(s) — - 4 Pw 15,
tU
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t 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
Z[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�LNo
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
E 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):
Re+c�;r w o.6 LA aj 0.k oxj.V1,l uwss aver pe IJ 5
�
` b (za a L~C t 4 w C � ¢ rj' L� C1 -5 5: �,���0V,_
]
k
1
LIDA .,
Reviewer/Inspector Name W 2I s—I f Ny-Qki Phone: 3C_X)
I
Reviewer/Inspector Signature: ` Date: ? /.F ZM
12128104 Conlinueil

.-.e
Facility Number: (D3 —� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P(No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1KNo
❑ NA
❑ NE
23. ff selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
DQ,NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
%I 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
[ANA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
W No
❑ NA
❑ NF
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
El
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑
33. Does facility require a follow-up visit by same agency'?
❑ Yes
5@ No
❑ NA
❑
Additional Comments and/or Drawings:
12128104

Facility No. L0 S __ Time In Time Out Date
Farm Name h C� t Ctr► Its rr�
Owner K Q7X Po(-VIr--3
Operator
Back-up
t
Integrator _ or V t i
Site Rep
No. _ I R3C/
No.
COC `'-_ Circle: General or NPDES
Design
Current
❑esi n
Current
Wean — Feed
Farro�—Feed
Wean — Finish
Feed — Finish
Gilts 1 Boars
Farrow —Wean
Othe
FREEBOARD: Design 1qz),4
Sludge Survey
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop _
Weather Codes
Observed
Calibration/GPM C(,/
Waste Transfers
Rain Breaker
PLAT Wettable Acres
Daily Rainfall
yl- ft-)
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
d .gZ
1-in Inspections
Date Nitrogen (N)
2 , .
rct
Pull/Field
Soil
Crop
pan
Window

:y�y;
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit lk Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �1 Arrival Time- �N) I Departure Time: ®County:
Farm Name: l V-\ J.1 Ca(l hl l S Owner Email:
Owner Name: N Ej C' �S l� �r IfYI S Phone:
Mailing Address:
Region:
Physical Address: ']
Facility Contact: U Z. Title: rQ'i (y) ��. Phone No; 7G rS'
Onsite Representative: Integrator: I 0 Q-V i S
V r
Certified Operator: C Operator Certification Number: a
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = . ❑ Longitude: = ° ❑ 1 ❑ 4I
Design Current
Design
Current
Design Current
Swine Capacity Population Wet Poultry
Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dais Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
ow to Feeder
Non -Dairy
ow [o Finish
❑ Beef Stocker
Non -La yers
Beef Feeder
Pullets❑
rs
6=1
❑ BeefBrood CowTurke
s❑
Turke Poults
r ❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 �INo ❑ NA ❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes
❑ No A
❑ NE
❑ Yes
❑ No 1;�NA
❑ NE
❑ Yes
IRNo ❑ NA
❑ NE
❑ Yes
PNo ❑ NA
ON I,
Page 1 of 3
12128104 Continued

Facility Number-6 _d Date of Inspection
1
M aste Collection & Treatment
F4. 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 N No ❑ NA LINE
Struc ure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in): -) I;Z?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ic/ large trees. severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes �5No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes�lo ElNA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �Mo ❑ 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 ol'Acceptable Crop Window �❑j Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) UK f `Y)uj Q t 1 , :S4� G1 r C) j S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ YesjNo
❑ NA
❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesNo
❑ 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 o� any other<comrnents
:Use drawings of facility to better explain situations. (use additional pages as necessary):
oA -e_vv(�
d U �t-ean -f S426 `Ze
Reviewerllns ector Name 1 ' I`,l Phone:
ReviewerAnspector Signature: ' Date: Y_ Z
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
i-vileuuirt:d Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA [IN I-
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes *o ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
��es
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27.
Did the Facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
&VA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes *o
ElNA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes � No
❑ NA ❑ NE
and report the mortality rates that were higher than normal'?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
ElNA ElNE
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 (� o
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency'? ❑ Yes Wo ❑ NA ❑ NE
Additional Comments and/or Drawings: , '`;
fit
tQrrtt�-�-
Page 3 of 3 12128104

Facility No. '� 1� ry Time In Time Out Date
FaFnName r_. integrator
Owner Site Rep
Operato _ No. c p
Sack -up
COC
No.
Circle: Gener I or NPDES
Design
Current
Design
Current
Wean — Feed
—
Wean — Finish
Farrow -- Finish
Feed — Finish
Gilts I Boars
Farrow —Wean
Other
FREEBOARD: Design
Sludge�Surve
Rain Gauge t% --
Soil Test
Weekly Freeboard V
Spray/Freeboard Drop
Weather Codes
PLAT
Observed
Calibration/GPM 1 ��
Waste Transfers
Rain Brea eti^r `�---
Wettable Acres
Daily Rainfally 1-in Inspection
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
o�5
Date Nitrogen (N)

Type of Visit t2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: Departure
1 ; G� 6 Departure Time: �, Ly County:
Farm Name: �L �a,,-- t; lls Owner Email:
Owner Name:._ E et f U_ i S �Q� S Phone:
Mailing Address:
Physical Address:
Facility Contact: _�DrJ V O%7"r_ Title:
Phone No:
Region: 1::--Ao
Onsite Representative: -J�Aa-Av cl— Integrator:
Certified Operator: flJ�� tip/` 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:
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
ElDry
Cow
❑
Non -Dairy
❑
Beef Stocket
❑
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 jr4"j' No ❑ NA ❑ NE
❑ Yes
1@ No
❑ NA
❑ NE
❑ Yes
r2 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
EQ No
❑ YFs
No
❑ NA
❑ NE
r Yes
jai No
❑ NA
ElNE
12128104 Continued

Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 54No ❑ NA ❑ NE
a. If yes. is waste level into the structural freeboard? ❑ Yes [ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / a ry
Observed Freeboard (in): / 7d/
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
M No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
r'�11 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
R No
❑ NA ❑ NE
maintenance/improvement'?
1 l . Is there evidence of incorrect application? I f yes, check the appropriate box below. [:]Yes
ERNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ 1-1ydrautic 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 Drib ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
21 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Reviewer/ins ector Name - "f: ' anyc�s i �!
P �.. d �.,.� r� • Phone:
Reviewer/inspector Signature: Date: V2—a-- 040
12128104 Continued

Facility Number:(3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZjNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O 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 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LZ No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[--]Yes
[KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[N 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
ENNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
14 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,1 No
❑ NA
❑ NE
� 0 Cr-D j2ye;ZJ i P-` N,7 r ,5 e,d-
12128104

IType of Visit O Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine p Complaint O Follow up O Emergency Notffication O Other ❑ Denied Access
Date of Visit: Time:
Facility Number (03
rO Nat Operational C Below Threshold
® Permitted 0 Certifiedd} 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ....................
Farm Name: ................. i''Ap.............. !!............................... County: .......?..�.t.......................... .... ... Fie......
Owner Name:....... G ..............................#..u4*y.... s......... ..4................. Phone No:....... .. �.v........ S. y..&.........a.�. ?................
Mailing Address: ....... S 4..�i.........�2..........,u'! :... �.sT?.t? t u .. N..,...L� :..................................................T 3? b^
........ ............ . .....................
Facility Contact: ..............................................................................Title Phone No:
Onsite Representative: •----•-.--= "-.-�-- ...........................................Integrator:
......... ..car.u.1S..................................... .................
Certified Operator:.----....................................----.............................-...................--•-•-----........ Operator Certification Number: .............................. ............
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �'� Longitude �• �' �'°
Design Current �. DeMgtf Current: Design Current
Swine ,
Ca acr ;Po""ulatton ,,;'Ppultry cap aci Po elation Cattle Caolicity Population
❑ Wean to Feeder i f ❑ Layer ❑ Dairy
❑ Feeder to Finish ;,,1
#,E ❑Non -Layer I I ; ❑Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish t�"l Total Design;Cao##y '
❑ Gilts
❑ Boars Total<SSL'W
;.
Nuniberbf Lagoons
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon []Spray Field [-]Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I lStructure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ..fl�?f?!'............ ....l..Gllk....... .................................... ................................... ......................................................................
Freeboard (inches):—
12112103 Continued

Facility ?dumber: Date of Inspection - 1 G -p. t
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. .Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ❑ No
(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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
%Vaste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W"UP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comiments (reier`,;tt yqueF.
stion #) lExpla[niany YEm"11 swersiaadfor{ any, ret ommendations nr any. other comtnents.
3 1i911�' 4V
Usedrawings oflfacillty to better explain sifitatious; (use additions[ pages as necessary) , `'I; ® ❑ i
field Conv Final Notes
i ..
S,rO t F� 4 P4 A ` aC�jL.
.3
Reviewer/Inspector Name r ,=
Reviewer/Inspector Signature: Date: /b o
O5103101 e:�I_ z Continued

�F�'j,-rt•� .t ;Cara n ! t _ ,n> -.t 3 �,— - -• - -_ - _
Ij!! ,��>G 4 "� : r� •Ni'�� i i s ti � � ! ins"�pT.�� t'P' i` t I i+i �J"ffP43��lt�f: i �.r. f [...�a i r � } r-1 I -- •- r r � i..t'rtr � r -!!� �•w iy a 1�. I
s1��M �t�r n};�h.� e� �lS' rr'F P�;•r < �, .�S ,y O �tilCrr'a�eoCyr � lf..>.:3��.. .u.:.� s .. d4 sk..uii.M•F'����Ss.'1, t i .� � F�� a uI - �r � rl -,-fir r ' I k
ritS;�oF!t! ��.• �, j •;,• ?,� � is �..r' Year 6 T'�x'a : ;<� ���s.'�Y,..�.a�',�'..��. y
Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint O Follow up O Emergency Notification C Other ❑ Denied Access
Date of Visit: Time: �2
FaciliriNumber t;3
Not O erational Q Below Threshold
® Permitted ® Certified ❑ Conditionally' Certified ❑ Re; istered pate Last Operated or Above Threshold:
Farm Name: Z.aCj i G e% County: VA on re -
Own er Name: U, Phone No:
Mailing Address: a5 04 S d ; eA !&d AT__3AS`
Facility Contact: I a V1 6 YA n n rc Title: Phone No:
Onsite Representative: 1 1:) n16 t^[_ Integrator: _ileU.iJi S,
Certified Operator: (-f Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 - Longitude ' �• �•6
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Po ulation
❑ 'kh�ean to Feeder I
Laver
❑ Dairy
❑ Feeder to Finish
±::::�❑
❑Non Laver
❑ Non-Dain,
Farrow to Wean
Farrow• to Feeder
O, i3
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
I Number of Lagoons U Subsurface Drains Present jU Lagoon Area iU 5prav Field Area j
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges S Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge ori;inated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is obsen•ed, was the conveyance man-made?
b. If discharge is obsen•ed, did it reach Water of the State? (If yes, notiN DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes
P No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes] No
❑ Yes No
❑ Yes ® No
Structure 6
Identifier:
Freeboard (inchesl:
05IV3101 ! Continued
��1z

Facility Number: (o — g Date of Inspection i =i
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes %No
❑ Yes W No
❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maimcnance/improvement? ❑ Yes (6 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes QR No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes CO No
11. 1s there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes @ No
12. Crop type ll �11 Ll , CZ "IL6 .. L r S
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [N No
14, a) Does the facility lack adequate acreage for land application'? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes (@ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required
Htcords & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available'?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
13 No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
R No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PQ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ic/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[+No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[� No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ytie tiaill':.'Wtl' knuGr #`x' . Pam@° YCP,�I'u . 11 "�-;-Ino'IlNhn "Jh'k.S+rBA'3� +@r a 'q pn ;,t` ° 16'ili "'v,i J i I� r I':;;::I"
Comments (rcfcr to=question# Explain any YFS�1lanswt hand/or any recomlmenlodalltlioneliir any„other comments: '';
Use drawings of facility, to tietter explain situations (iise adtilfianal
pagesPaslece"scary}, [] Field Copv ❑Final Notes
I a�JM:NII1�� .?d?!II"I�UIIi��PJ�VPall"��.
r -
!�' 111 j (�8-v - d-" fr[ rdv l� o t ed
Hy
Reviewer/Ins ector Name
p
-ZE5:1
ReviewerAnspector Signature: Date:
05103101
FA
Continued

Facility Dumber: (;, ;3 - 8 Date of Inspvction
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours`'
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, andJor public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes &I No
❑ Yes ® No
❑ Yes [4 No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings: .
AL
05103101

outine O Complaint O Follow-uE of DWQ inspection Ofollow-ug of DSWC review O Other
Date of Inspection u
Facility Number Time of Inspection I /3 1s Use 24 hr. time
`�+up Total Time (in boars) Spent onReview
Farm Status: _ or Inspection (includes travel and processing) � s
Farm Name: .+' a,r E4 f County:ert
Owner Name: D21vfF. Phone No: c9(2)94L2;41
Mailing Address: S' `{
Onsite Representative: l A 94 V%L � hk& Integratar:
Certified Operator: S °- Operator Certification Number.
.Location of Farm:
Latitude Longitude �• �� 0�
© Not O erational Date Last Operated:
Type of Operation and Design Capacity
t
"P[[��.�,"" :..
.? `r t=N
oulunibec little= :4 a�Number.,��
ji 'r''�� l.Y. .
❑ wean to Feeder � �� .:. pia
❑ Feeder to Finish &'"
❑Non-k ❑ Beef"
fl wt i�v ?.�6 fti.1 .�,•,,r . `r°i.rw i3°1;'�'�.. e-xw'...'hy'^` �,"y�"°.`.`a f ii"'��`j.�,.
arrow to F'ni "fs Y 0 Other Type of Livestock : _ �tf
R l'�F
'?•W '9
,.,tse G. �;w,=^i-ri;x• ,.4< '.l.- �.3�4'Y%xi.'yfi, { :-'��?O� .. Y' .�..-. ,'�?'�ae �i.,'.,"�.�ti:..,"a'""R'A;,"r+,";'�,'"�'�ar - .,xe. t ;r-ea �• F�,��re ""�' � .., �"',�,�,.�:.,
�h x Number of Lagoaus 1 Holding Ponds.�,❑ Subsurface Drains Present
❑ Lagoon Area Spray Field Area-4a
ttetal
I. Are there any buffers that need mainteaancelimptovrment?
2 Is any discharge observed from any part of the opmz ion?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
e. If discharge is observed, what is the estimated flow in gaMnk?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
d. was them any adverse impacts to the waters of the State other than from a discharge?
S. Does any, pan of the waste management system (other than lagoons&olding ponds) require
. _. _.. . - .. maintenausxiumprovsment? -
❑ Yes Zlo
Yes tjNo
0 Yes ANo
❑ Yes aio
13 Yes &No
0 Yes two
© Yes PNo
❑ Yes Il No
_ / . .. I . • —...

Is ficility not in compliance with any tpplicable sadmck ahats? E3 Yes ONO
7. Did the facility M&U to have a ea tified operator in responsible charge rif inspection after I/M? 13 Yes QNo
8. Are there lagoons or atomp ponds an site which need to be properly closed? Yes MNd
jMsMra (Lagoons and/or Holding Pgot)
9. Is structural freeboard less than adequate? Yes 8 No
Freeboard (fly. .LagoonI Lagoon GAD-) Lagoon 3 lap=4
10. Is seepage observed from any of the structures? M Yes ONO
11. Is erosion, or any other &=u to the integrity of any of the structures observed?
Yes ONO
22. Do any of the structures need maimenan Vement?
E3 Yes SNo
(If any of questions 9-12 was. answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWG
13.Doany ofthe structures lack edqua markers toiduffystart and stop pumping levels?
❑ Yes No
Waste AP
14. Is there physical evidence of over application?
E3 Yes &N6
.(If in excess of WM, or runoff enuring waters of the State. not* DWQ)
15. crop type aut=6
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
CFY=—ZfWb
17. Does the facility have a lack of adequate acreage for land application?
M Yes BNo
I S. Does the cover crop need improviczamt?
❑ Yet Rio
19. Is there a lack ofavallable irrigation equipment?
13 Yes E3 No
for Certified Eaggig
20. Does the facility fail to have a copy of the Animal Wage Management Plan nmmy available?
21. Does the facility fag to comply with the Animal Waste Management Plan in any way?
G1W-E3NO
22. Does record knTing need i
EVea Mo
23. Does facility require a follow-up visit by same ajpp-y7
13 Yes M:N0
24. Did ReAewedhispmor fail to discuss review/inspection with owner or Operator in dwp?
13 Yes 43 No
O ly
C_Sapswen� 'n crany.n!pmmenidid arnentsO. qns. or kny o -cc r
Ij
.
Av r 4v'y 'tAxqaeii t'3'D P .0 #NOW
Z
Reviewerfinspemr Name
Re"w"Anspector Signature: DxW. 411111-7
Dlybion of Miter Quaft Water Quaft Sec on, Fad14 Assessment Unk fill A ffi-C

Site Requires Immediate Attention:
Facility No. 4,3- V
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: // 09
Farm Name/Owner: n1. Cy. :a,;t,1r s �, t, -4 - aQ W,9 A.) J/i/�.5 F;�2 lq
Mailing Address: W:5/ . r` 10 Bmdy.s. _&)c
County: 1f
Integrator: Phone:
On Site Representative: 111,b Phone:'/261—
Physical Address/Location: 1> r 6e
-- /d IIW>/o AZW v 70-T-
Type of Operation: Swine __9 Poultry Cattle
Design Capacity:/ZoDSOW, FrA71•Ftt&V.-Number of Animals on Site: f
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches es or No
Was any seepage observed from the a oon(s)?
Is adequate land available for spray? es r No
Crop(s) being utilized: `8
Actual Freeboard: 13 Ft. Inches
Yes or I& Was any erosion observed? CSO� or No
Is the cover crop adequate? 69br No
U 1�>6'r + 3 S A, ,.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? U or No
100 Feet from Wells? es ®roIs the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or&
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ovCN:a If Yes, Please Explain.
Does the facility maintain adequate waste management records (vines of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o No
Additional Comments: / s o,,)/a1 e
LA)/Tif 51,11
All �11s_.17_ZE
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B, Howes, Secretary
November 12, 1996
N.G. Purvis Farms
Indian Hills Farm
2504 Spies Rd
Robbins NC 27325
SUBJECT: Operator In Charge Designation
Facility: Indian Hills Farm
Facility ID#: 63-8
Moore County
Dear Faun Owner:
RECEIVED
NOV 12 1996
FAYETTEVILL-1
pFr%. OFFICE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which desigrfates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 91gn33-0026.
S2Preston
AHoward, Jr., irector
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 27687, N7W FAX [phone]
Raleigh, North Carolina 2761 1-7687 'WfC An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/100% post -consumer paper

Site Requires Immediate Attention:
Facility No. 6,3- 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: /1: 0Q .
Farm Name/Owner: _ A). G.—PUA 010 �yy e ,4 — g4ajoj "l /1- PAR PM
Mailing Address:
County: E
Integratc
On Site
Physical
Type of Operation: Swine )e Poultry Cattle
Design Capacity: /20o sew Fw� as FA.b,.Number of Animals on Site: i��a so.•�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude• Longitude• "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximatety 1 Foot + 7 inchesYleeDor No Actual Freeboard::1 I Ft. Inches
Was any seepage observed from the a oon(s)?
Is adequate land available for spray? es r No
Crop(s) being utilized: C0A!5 r t_ _BERM
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling . 'e or No
100 Feet from Wells? es or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or l&o
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(Ro:) If Yes, Please Explain.
Does the facility maintain adequate waste management records (vo mes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o No
Additional Comments: IA4ac.J s/,r s .s�,�o x �e� ��ee-ors shed/� '1�e
X; - A L)
Inspector Name
Yes or&Was any erosion observed? <!&or No
Is the cover crop adequate? es r No
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. 6, 3 - g
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:. XV , 1995
Time: /1 : of
Farm Name/Owner:
Mailing Address•.
County:
Integrato
On Site 1
Physical
•z-f'-
Type of Operation: Swine -Y- Poultry Cattle
Design Capacity: 10-oo5gg. F,,,.. ygmh,Number of Animals on Site: irvo
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude• Longitude• "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches or No Actual Freeboard: !, �—;Ft. Inches
Was any seepage observed from the a oon(s)? Yes or & Was any erosion observed? (& or No
Is adequate land available for spray? e�r No Is the cover crop adequate? 4gbr No
Crop(s) being utilized: C -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling!? or No
100 Feet from Wells? e or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or©o
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or[No) If Yes, Please Explain.
Does the facility maintain adequate waste management records (v9jumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o(to)
Additional Comments:. /AA _ ...... .BR_e��rs S�od1_e_.�.6i/scams
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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