770003_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: *-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,+,Departure Time: County: 4H 4w' Reglon:
Farm Name: %J _ 'y y�, "� L I—C Owner Email:
Owner Name: Fay VytS Lv— Phone:
Mailing Address:
Physical Address:
Facility Contact: G4 C OPV S Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm;
u
Latitude:
//P'h++one:I e -
Integrator: L RG`It�t� 1tMs
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Laver
Design
Cattle Capacity
Dai Cow
Current
Pap.
Wean to Feeder
Q Non -La er
El
DairyCalf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
p
Design Current
D P.aultr, Ca aci .
Layers
P'Non-Layers
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[� Yes M No ❑ NA ❑ NE
[]Yes [] No
[:]Yes []No
[:]Yes [-]No
❑ Yes No
❑ Yes No
Ep NA ❑ NE
® NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

acili umber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(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
waste management or closure plan?
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
Ili No ❑ NA ❑ NE
No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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? LT
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 nd Drift ❑ Application Outside of Approved Area
12, Crop Type(s): L�:1RsT�i/[ + �'' a G-.�5 a S4-t^ ., sju. Gr� Ove-�
13. Soii Type(s): Alt--1:,
14. Do the receiving crops diff r 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
CP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
��TT
❑ 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
E� 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
[P No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ig No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

1�
Picillty Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to'secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (� No
Other Issues
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
(P No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refr to questio..n-- #-)- Ex.,l_a,i.n..,a.nyY.E.S snewers...n=ndl5o, r any. .'7add_fi'tieo, .a_Yl'.Vieom.,ndatonsor.. aR n.yxl oSt?h•.$.r, co^`.z;: €en njkt' � ai.;"e?' 1.cme_. m5�i9
P064 M"f_(C�ea
91o42y-L!o yT
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9'e�� " r'
Date: l
21412015

1jKM R/2-111-7
Division of Water Resources
Facility Number - 0 pivision oT Soil and Water Conservation
0 Other mEDn y
Type of visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: !® Departure Time: County: 91'C+41ytiAegion: /"79-i✓
Farm Name: ��lyyhs CC( Owner Email:
r
Owner Name: J — ,D 1 tw r LLC Phone:
ih
Mailing Address:
Physical Address:
Facility Contact: AaL J-b ew S Title:
Onsite Representative:
y
Certified Operator: 14
Back-up Operator:
Location of Farm: Latitude:
PhoAe:
Integrator: 1, c
Certification Number:
Certification Number:
Longitude:
Design :Current
Design
Current
Qesign Current
Swine
Cpty
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
73�F
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dr Cow
Farrow to Feeder
D'r, P,nultr,
C•.a acit
I;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Otherhim
Turkey Poults
1RU2=1
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (Ifyes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ YesLN
No
NA ❑ NE
® NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Vac ili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
r" 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
;E No
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
[�5 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
F No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�Z 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
❑ Evidence of Wind Dris ❑ Application Outside of Approved Area
❑ Outside of Acceptable Crop Window Drift
12. Crop Type(s): �Pil' 6,jo S Jlti, �•
t�
13. Soil Type(s): 04 &C:4
14. Do the receiving crops dif r from those designated in the CAWMP?
❑ Yes
E] No
❑ NA
❑ NE
IS, Does the receiving crop and/or land application site need improvement?
❑ Yes
7 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
P 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 M 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 9 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Vacility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[4 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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? (Le., 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?
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [X No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes �@ No ❑ NA ❑ NE
❑ Yes [5a No
[:]Yes ® No
❑ Yes C@ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412015

iype or visit: w uompnance inspecrran v uperanon meview v arrucrure r,vaivauon 11 lecnmcai 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: 1 PSI.?-0 Departure Time: �County: PIAJ12&�49 Region:
Farm Name: r1s Lam— Owner Email:
Owner Name: �Zwrh �C- Phone:
Mailing Address:
Physical Address:
Facility Contact:g paL Jokwg Title:
Onsite Representative: G
Certified Operator: il.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: j 1'.1'k
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine
Capacity
Pop,
Wet Poultry
Capacity
Pap.
Cattle MEpac aity
op.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
570
Non -Layer
I
Daia Calf
Feeder to Finish
OO
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr,
Ca acit
P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I
Other
Discharges and tream Im acts
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
XNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
®No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: --3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [�7No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No MONA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes rp 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 ro [ ] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require ❑ Yes EpNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes r 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 ❑ r
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 [jEv0enc&Vf 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?
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?
❑ Yes
No
❑ NA
0 Yes
No
❑ NA
❑ Yes
ip No
❑ NA
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
❑ NE
❑ NE
❑ NE
M No ❑ NA ❑ NE
1PNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes y 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 1P No
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

acili PNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [� No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes EP No ❑ NA ❑ NE
[:]Yes P No ❑ NA ❑ NE
❑ Yes I M No ❑ NA ❑ NE
LP
❑ Yes §d No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone:
Date: 04
21412014

type of visit: ® F-ompuance inspecnon ;,.j uperanon meview V btructure r vaivatnon V t ecnmcai Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I M.00 or,,l Departure Time: O County: P,1CAk4W49 Region:
Farm Name: ,� � r--t S LLC Owner Email:
Owner Name: U—0 ram' M g LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: mccc_. Q ©ros Title:
Onsite Representative: ( f
Certified Operator: U
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: SW t\k
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Rapacity Pop.
I Layer
Design C►arrant
Cattle Capaclty Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish '
DairyHeifer
Farrow to Wean
Design Current
D , P,ouitr, Ca acit P,o
La ers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
I 10ther
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[] Yes ❑ No
❑ Yes No
❑ Yes No
�NA ❑ NE
[a NA ❑NE
NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

F
lFacility Number: 7 - j Date of Inspection: S/23& 1f i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[9 No ❑ NA ❑ NE
❑No �NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2- j u
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.) r
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? h
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
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 /E] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
[] NA
�NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA F NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failurc to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence f Wind Drift ❑ Appl
ication Outside of Approved Area
12. Crop Type(s): �9-tot s • QL
13. Soil Type(s):gL,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
DNA
� NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
O?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
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 0 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 [5] 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No ❑ NA W, NE
❑ Yes ❑ No ❑ NA [P NE
❑ Yes ❑ No ❑ NA [P NE
❑ Yes ❑ No ❑ NA P NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
[� NE
❑Yes
❑No
❑NA
®NE
Phone: `r ��"�yj • 77
Date:
21412014

Type of Visit: • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 00 i„ Departure Time: County: Region:
Farm Name: D t; ,Pwg LL( _ Owner Email:
Owner Name: �" V P",y S L (—c Phone:
Mailing Address:
Physical Address:
Facility Contact: Mac— i '
/ "lVj - Title:
�r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
'Design
Current
Design
Current
Design Current
Swine
Capacity
Fop.
Wet Poultry
Capacity
Fop.
Cattle Capacity Pop.
can to Finish
FTLa er
I
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
fljo
7jQ12
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D ZYRWUlt ,
Ca ael
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
ITurkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes W No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
Q§ NA
❑ NE
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 FINE
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

Facility Number: '1 7 -3 j Date of Inspection: �L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
r;A NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(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
tM No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
[3 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[4 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
rM 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): `'�.�W VI^�d� c4Si cpct N), Si' lr-wl-ti &v2
13. Soil Type(s):
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
[M 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?
TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box,
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes No
❑ NA ❑ NE
[� Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

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 �g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4] 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 ReviewerlInspector 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 W No ❑ NA ❑ NE
❑ Yes '�] No ❑ NA ❑ NE
[—]Yes � No (DNA ❑ NE
❑ Yes P No [] NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Phone: L IOL�
Date:iE�
21412014

IA- g1tiu(14
W Division of Water Quality 11
Facility Number - �❑ O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 40 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 3 [. Arrival Time: D 12,,, Departure Time:Ft . p 4^. County l� ylip Region:
Farm Name: f - 2 Fyw,4 r, Z� C
Owner Name: T) i;;,
Mailing Address:
Physical Address:
Facility Contact: Mac. '-I-a ry 5 Title:
b
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
u
Latitude:
Owner Email:
Phone:
Phone:
Integrator: O Vxnv,re, = cd
61
Certification Number: 'Z
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
iO Oo Non -La er
Wean to Finish
Wean to Feeder :41WI3
Feeder to Finish
Farrow to Wean
20
ODO
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Pnultry ranacity Pon.
ers La
Non -Layers
Pullets
Turkeys
TurkeyPoults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes M No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
P NA ❑ NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ No Nn
p NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [3 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

Facility Number: 7 71 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;g No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ® NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
W No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4'-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�] No
❑ NA
❑ NE
maintenance or improvement?
Waste Al2 lication
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 P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
+ ❑ Application Outside of Approved Area
12. Crop Type(s): Cat i- r�1' "_CSS
13, Soil Type(s): AL
`f-,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes P No
❑ Yes [P No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F ft Number: 'J - Date of Inspection: �3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Lp 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?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes FM 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.
Use drawings of facility to better explain situations (use additional pages as necessary).
i
Reviewer/Inspector Name: IV„fO Phone:
Reviewer/Inspector Signature: ' Date:
Page 3 of 3 21412011

Ma G U Title:
Onsite Representative:
N
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: OM 11 Gh
Certification Number:
Certification Number:
Longitude:
Swisne
Design CurrentWON
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design t►urrent
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
7O2e�
Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
Di, I;oult , Ca aci P,o
Layers
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Itype of visit: wuompiiance inspection U uperation rceview U structure r vaivation U Iecnmcat 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: I Departure Time:® County: R1W,WQA)0 Region: �O
Farm Name: ::5 �y45 , LLC Owner Email:
Owner Name: �" D . r y, [ , CL C Phone:
T '
Mailing Address:
Physical Address:
Facility Contact:
❑ Yes [P No ❑ NA ❑ NE
❑ 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)
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 ❑ No
❑ Yes No
❑ Yes [�LNo
NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: -3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
f�] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
`P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
T®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�PNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P 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
12. Crop Type(s): C `i l a 4 CUSS (Aah-e), G-ATh 6 M!!
13. Soil Type(s): .,W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
T�
❑ 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
`P 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes i No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

�t, Number; - Date of Ins ection; 2
r
.� /.
\\ d the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;0 No ❑ NA ❑ NE
21. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CK No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other 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
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
�a No
❑ NA
❑ NE
[]Yes
M No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
bg 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
;omments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Jse drawings of facility to better explain situations (use additional pages as:.neeessary).
paw A-Y-'.e4J. �Ila,�a��, �i'la" has t`4�
4L
F,J, `S �, 6 300
aft .
5�60
Reviewer/inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: ? lD" 4 33-33 00
Date: 2 kS 13
21412011

3/2JI t
W Division of Water Quality 11
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: e Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: a— Arrival Time: Departure Time: County: ptJQ
Farm Name: DES } Lj_[ Owner Email:
Owner Name: S, Phone:
Mailing Address:
Physical Address:
Facility Contact: AAQ C. Title:
Onsite Representative:
Certified Operator: 14
Region: F-P-0
Phone:
prL� s
Certification Number: 4-4U 10
Integrator:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Uapacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkev Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry, Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 55 No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [] No
❑ Yes ❑ No
❑ Yes ER No
❑ Yes 1P No
0 NA ❑ NE
E� NA ❑ NE
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility- Number: - Date of Inspection: :Zf7 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No RKNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1� 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? 0
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
S. 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. Arc there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rnNo ❑ NA ❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fF 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 Cro Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): & ' L -l`� 'L, _�,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 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 CAW -MP 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 C�pNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1;1No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Faciii Number: Date of Inspection: ,2
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No
the appropriate box(es) below.
Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
Mr No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
`';No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments "., t'
Use drawings of facility to better explain situations (use additional ages as necessary).
,��f, (�r�r�rC,,•�b� was � rh Zvll�
G� ��-✓ Mw,.c.� ZoJ2�
cy 7101 Z,
5l•� S i� �,� 5 � n�1
5 bi�L 5 + 0_ y e' 16, via S
2009 �/0
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: -! /0'q3') s3oy
!lei Ma'a Date;
ah q4 p-
21412

��Itz
f ` - 0 Division of Water Quality
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 17134 Y, I Arrival Time: QLGn Departure Time: 03;cx7 County: M Region:F-PO
Farm Name: i7 !!a , L_LC. Owner Email:
Owner Name: D Fzt,-rrk.S+ LL C_ —IAac TVy S Phone:
Mailing Address:
Physical Address:
Facility Contact: !' I a G 1-0405 Title:
Onsite Representative: LI
Certified Operator:
h
Phone:
Integrator:S
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop,
Layer
Non -Layer
ury rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [+ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
❑Yes No
[:]Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

[Fatility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): so w
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PQ 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? I
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 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
r5"
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [y] PAN a l 0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[P NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
MR 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
'A NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
MrNE'
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
[R NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
D. No
❑ NA
rNE
❑ 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
21412011 Continued

Fatili 'Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ?
❑ Yes
❑ No ❑ NA Mn 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 CpNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 Yes
[]No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[:]No ❑ NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No ❑ NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No [DNA 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 fait 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 Kn NE
Comments (refer_ to:question #): Explain any YES answers :and/or any Additiona.l:recomurendations or any, other comments
Use drawings. of facility to better explain situations. (use additional pakesYas `neces'sary)
A6 -0_'X" ess( v c s r%"W n o W ( II
"J_ a�_ 4� I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ire
< < f Caw — a l`
Phone: `1�0✓ (9 3 /�
Date: 1% 71
2141201

Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency Opp 0�ther ❑ Denied Access
Date of V&R-4
'Visit: Arrival Time: D;l c.n Departure Time: j: County: 404D,V0 Region: 11240
Farm Name: fi m4 ti U i; Owner Email:
Owner Name: �` Q Pow vv-,_� . U C, ___ __ Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu.J G"'Q Titic:
Onsite Representative:
G
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 4Pr
Operator Certification Number: -ZZ"D`'0
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ I ❑ 11
Longitude: ❑ e ❑ 6 ❑
Design Current
Swine Capacity Population
Design Current
Pou
Wet ltry Capacity Population
Design Current
Cattle City Population
►apac
ElWean to Finish
❑ Layer
El Dairy Cow
ElWean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
Farrow to Wean
j_ 2 ' ,thin
Dry Poultry
Layers
ElNon-Layers
El Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
❑Dai Heifer
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
El Feeder
❑ Beef Brood Cow
Number of Structures:
Farrow to Feeder
El Farrow
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
DischaEges & 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?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes M No ❑ NA ❑ NE
[I Yes
❑No
PNA
El NE
❑ Yes
❑ No
[)9 NA
❑ NE
23NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
fjj No
❑ NA
❑ NE
12128104 Continued

'Facility Number: — Date of Inspection �7 j _J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ,�§NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
w
Observed Freeboard (in): ;33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N 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 12 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ['No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [PNo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift^❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops difftr from those designated in the CAWMP?
❑ Yes
E�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
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
Comments (refer to question#): Explain any VES':answers and/or any: recommendations or any�other: comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
A6
Reviewer/inspector Name
1 Phone: �—
—3360
Reviewer/Inspector Signature:
t Date:
Page 2 of 3 12128104 Continued

� =w
Facility Number: — Date of Inspection
Reguired Records & Documents
14. 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 PM No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t 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
EP No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fait to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
24.
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
EPNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E�j No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

r
Division of Water Quality
111 Facility Number 3 O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit 40 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0Rout1ne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: oZ f'a Arrival Time: %ZO Departure Time: Q2 County: RIT77 Region:
Farm Name: -�I - V T`U rr►IJ ULA
Owner Name: Mot C ToV 1e S
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Nt a c, Title: Phone No:
V r
Onsite Representative: Integrator: ; fir► 0..t,,,"7
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude: = o
Back-up Certification Number:
0" Longitude: 0 0 0 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean O
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other --- -- - - - - .�
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ED
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 ;9No ❑ NA ❑ NE
❑ Yes
❑ No
1PNA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
F�t NA
❑ NE
❑ Yes
❑ No
❑ Yes
CWNo
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
Page I of 3 12128104 Continued

f Facility Number: 7— Date of Inspection 2 O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
%jNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 2!PNA ❑ 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
Q�)No ❑ NA ❑ NE
Oc/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[n 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
P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EPNo ❑ 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
CgNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
JgNo ❑ 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 Window Evidence of WindDrift El Application Outside
of Area
CyCrop Wind`
j❑
12. Crop type(s) C=c,4n_l k.-WILi4 �tf�x, �`�yT"""`�/ 1 U)i�+` &V' 41-1
L4a 1
■
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M 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 iand application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
Commcrits (refer totlquestion'#) Explain,sny YES answers,and7or any recommendations}or any ntl►er comments )„
Use drawings of facility to better. explain situatious. (use additional pagesrasinecessary)i +,:
T
ReviewerAns ector Name t�
rt 4
( Phone:
1'� .
9/D 3-3300
Reviewer/Inspector Signature:
Date:
I 11D
Page 2 of 3 12129104 Continued

r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P 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 09 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [6 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CS 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
D9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�,No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� No
El 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
9jNo
❑ 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
KNo
❑ 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
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;& No
❑ NA
❑ NE
Addit 4iial Coe'nfs` and/or Drawings�yy 1 � inm
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: [T5Tqyam, County: KTZW�WP Region:
Farm Name: A �{� LLC Owner Email;
MOwner Name: aC__T0►' t& Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
4
Phone No:
Integrator: 5 1
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 ` = Longitude: = ° = i =
"C-aue-i—ty
C rrent
Design
Current
DeSwine
pulx�tion
Wet Poultry Capacity
Population.
Cattle C**apmcity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
EK Farrow to Wean
Dry l'o�pltry
❑ D Cow
❑ Farrow to Feeder
❑ Non-DaiLy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IRNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
CJPNA
❑ 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
[PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C!�No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

:J
Facility Number: ri— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�JNA ❑ NE
Structure 1 Structure 2' Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /l
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
'7 No
WN
❑ 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
1PNo
❑ 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)
rr
9. Does any part of the waste management system other than the waste structures require
❑ Yes
10 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
29 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
SNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s) AI f PL, , Ve f i;
r•
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
%No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
TNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
n No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
$No
❑ NA
❑ NE
Page 2 of 3 12128104 Continued

Facility Number: — 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 P5No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
& No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JZ[No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 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
Ej No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
69 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 5QNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
55No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®.No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Page 3 of 3 12128104

10 Division of Water Quality
,w
=Facility.mber
0 Division of Soil and Water Conservation
0 Other Agency.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assis=Access
Reason for Visit 0 Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0OOther ❑ Denied �Q.�
Date of Visit: ap 00 Arrival Time: Departure Time: County: r'%J"pq Region: ` 'w
Farm Name: -;S--D FurMS LLL Owner Email:
Owner Name: Aar_-�Y-Orvs Phone:
Mailing Address:
Physical Address:
Facility Contact: NiQL_S�neS Title: Phone No:
►1
Onsite Representative:
Integrator:
Certified Operator: � Operator Certification Number: 12.120qo
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
❑ Soars
Other
❑ Other
Back-up Certification Number:
Latitude: 00
0 & = 61 Longitude: = ° = ' = "
Design Current Design Current
Capacity Population WetPaultry Capacity Population
❑ La er
I� Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design- _ . Cur
Cattle Capacity P'opui
❑
Dait Cow
❑
Dai Calf
❑
Dairy Hcifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
Beef Brood Cow rr
1=
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
ES NA
❑ NE
❑ Yes
❑ No
� NA
❑ NE
*NA
❑ NE
❑ Yes
❑ No
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: '-�'r-3 Date of Inspection ' 1
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?
El Yes
�No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UNo ❑ 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?
7"
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
EpNo ❑ 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
5INo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
V2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
118 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use of facility to better explain situations. (use additional pages as necessary):
�drawings
GFarm , ZX ce(kA+ recovrJ kezpb •
•
1. keep vjg-4,%k5 or, 6-tarn on L.ayo&v
Reviewer/Inspector Name Phone: /0 '3?CG0
Reviewer/Inspector Signature: Date: aOLLDI,98
12128104 Continued

Facility Number: ' - 3 Date of Inspection
Required Records & Documents
q
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 IS No ❑ NA ❑ NE
the appropirate box. ❑ W-Up ❑ 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 [I Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[P 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
12�No
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�LNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
$1 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E;No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
f,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit S Routine 0 Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access I
Date of Visit: I oV� Q Departure Time: 1 •,� am County:
b Arrival Time: 8•
Farm Name: -3 ` D F+"m . LUC n Owner Email: _
Owner Name: —AQ C__ 3-Ones ,U �h., el W� Pho'�'37.�
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: p
Certified Operator: r
Back-up Operator:
Location of Farm:
Al C �283,63
� YYlO Region: ��
Operator Certification Number: a
Back-up Certification Number:
Latitude: [= Q =' = Longitude: = ° =' =
Design =@U
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apacity Population
❑ Wean to Finish
❑ Layer
I 1
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
I I
❑ Dairy Calf
❑ Feeder to Finish
❑ DaiEy heifer
Farrow to Wean q= I L/076Dry
Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
La
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
©thcr
❑ Qther
❑ Turkey Poults
❑ 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?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
P2 NA
❑ NE
❑ Yes
❑ No
rNA
❑ NE
(VrFNA
❑ NE
❑ Yes
❑ No
El Yes
WNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: qr7—_3 Date of Inspection 1 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No N NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f9 t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [4No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [ANo ❑ 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? f� Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �lo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�4 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
f 0 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): .
71 Con41nug- oh ire a4etas oh LQ jr. oo r7 i
Reviewer/Inspector Name 1 Phone: j0 3
Reviewer/Inspector Signature: Date: ?L7D
Page 2 of-3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropriate box. ❑ WDp [j Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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 1ANo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �TNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
56 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�lNo
❑ 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
rZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[,VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

s
Type of Visit ipopuline
ante Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: I Region: �`'
Farm Name: 1paf Dl is Owner Email:
WX Owner Name: 1 r\ _cam Phone:
Mailing Address: 1 1 D Co_czncLi✓ k_,d .. _ Mr sA Y i U C
Physical Address:
Facility Contact:
'S et,ryjL
Title:
Onsite Representative:
Certified Operator:"""'�'�-� ► ��,14.�n� 5
Back-up Operator:
I " Phone No:
Integrator:
Operator Certification Number: ;;�b o
Back-up Certification Number:
Location of Farm: Latitude: a Longitude: 0
f Z, M► ► e- e V S I "n CoTQC- ! I 5 b41c-
Design Current Design
Current
Design Current
Swine
Capacity Population Wet Poultry Capacity
❑ Layer
Population
Cattle Capacity Population
❑ Wean to Finish
❑Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dais Calf
❑ Feeder to Finish
❑ DairyHeifer
arrow to Wean
Dd b
Dry Poultry
❑ D Cow
El Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Cowl
❑ Turkeys
Other.
❑ TurkeyPo Its!
❑ Other
❑ Other
Number of Structures:
DischaMes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
)41o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
A
ElNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
❑ No
TNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
—r----
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
'UNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�VNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ffo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — p ()31 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes UNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes /❑ No 5j::NA ❑ NE
Structure I. Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: !
Designed Freeboard (in): !
rr
Observed .Freeboard (in): r-7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ONo
❑ NA ❑ NE
(ic/ 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? IC71Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ANo ❑ 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
o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Po ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
)fNo ❑ 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 types) — (--if0xf- t as o L, 7VGw?b_n
13. Soil type(s) [- 1
0-
14. Do the receiving crops differ4om those designated in the CAWMP?
❑ Yes o
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ,
❑ Yes 'io
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )To
❑ NA
❑ NE
' ,
Owner
has sate barn- Sp-ks b-n emkan� A 0,s Ph,?
46
y,� ,,,�
Icc,ss�
rt Y�17-r`
i` r1 S61Y�Q 50 J a^J, � N7UIC,f� �a SAP7op'
.4,1h '
srts, e h .
,6,de slope_need mou i %e
Reviewer/Inspector Name j. �• Phone:`? 1Z1 7-J,5
Reviewer/Inspector Signature: Date: (A �O
1212404 Continued

Facility Number: -Ob 31 Date of Inspection a 0
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 1�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 14 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )fNo
❑ 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 JANo
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes V.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 'rWNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ( No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
12128104

r �
F
Facility Number Date' � 0 Time INqSr Out
Owner
Farm Name � r—(a Y rn
0.I.0 ei ,b'Its No. a.
C.O.C. General NPD
Design Current Design Current
Wean to Finish Wean to Feeder
Feeder to Finish w to e 600
Farrow to Feeder . Farrow o 2nish
Gilts .. Soars
Qther
Soil types ,
j oV
Crop Types Pan ' Window
l l ` 11, 4,pri�
jn .. .
tIJ� OTC L in S� od .n'�✓
Vl f OZ7 O
Soil Test Plat
Designed Freeboard Observed Freeboard
Rain gauge , Rain breaker Daily Rainfall Waste Transfers
Calibration of spray equipment G.P.M.
Sludge Survey Crop Yield- 120 Minute inspections
1 in. Rain inspections Weather code Weekly Freeboard
Pumping time
Waste Analysis % & Month
Comments
v \ I U� U--

Type of Visit S Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 4DComplaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: QS Arrival Time: D: SA Departure Time: County: A.0_G_h_r._a_w Region: l-Iza
Farm Name: „ ,,�., Q .,,., Ca r VV% s L C- Owner Email:
Owner Name: _ryl c c. _ 4 1"__ Lo n �� 1� �,�_� t Ak) b a �- Phone:
Mailing Address: 1 7 D a T h, c r—jQ_ ,_,..,.M¢+s-t'oN. N C a�3Ga
Physical Address: -(12 In -l-c,r se-CA-k QK w VA t.P41s n e-av12 "'m hp+.
Facility Contact: Title:
Onsite Representative: Yl"�
Certified Operator: a.
Back-up Operator:
Location of Farm:
Phone No:
Integrator: %, T.S 4s R Al,
4. &v �w,k
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = i Longitude: = o = '
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ La er '
❑ Non -La et1.
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean L4uou
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes U No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
X] No
❑ NA
❑ NE
12128104 Continued

Facility Number: `77 — 3 Date of Inspection tY o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA '® NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA ® NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? []Yes
❑ No ❑ NA 5NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA Q 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 (X] NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA ® NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
M NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
EN NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑
Yes
❑ No
❑ NA
[ja 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
t/ is ,f'C� a relw�f a ca..,p �� �'.�7` /� oct - f�r�a cr i`�q i'rr �-hL -,= J /I.
MY. Jane- �e,4C o_rC T
ry7er,, V0a� CQr%'1**'L STa<_ no rf.�wrt( tt'On�G �l4G�
er ~;^%_It) 00j `7-1.3`6.s• Dtog JiT 7,e b�.irhW� Hu
eI�� Mrt a�' pu.►,��,,f A.vf +-keL, places adf
Reviewer/Inspector Name ��a r /3a `e �a.�l K " n��„' {W. Phone:
Reviewer/Inspector Signature: Date: <i // y 0-5-
/ 12128104 Continued

N
JJ{P/��i. �I +'kiar,•.. it'll' S r J' �' i
r7F
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Type of Visit 40 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility' Number Dam of Visit: Time: l0 O
Not O erational Below Threshold
® Permitted ® Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ._3 , kfc cno S Ll_C County:
Owner Name: '1Mra,C,- 5h 6-.e C Phone No: 1 n C, P 2 R 3 b fl
Nailing Address: 1,3'tj (in r, n a C Rc, _ �g3 G 3
0
Facility Contact: Q S IKccg Title: Phone No:
Onsite Representative: tAC-r- Integrator: C_<,i`ai -I
Certified Operator: 1e CM C,c r._h'sri Operator Certification Number: 12 0 4 Q
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 0 u Longitude • 1 0 if
Design Current
Design' Current
Design Current
Swine Capacity Population
Poultry Capacity Population Cattle.
Ca acity Population
❑ Wean to Feeder I
JEI Laver ❑ Dairy
❑ Feeder to Finish 1
10 Non -Layer I I Non -Dairy
® Farrow to Wean
Farrow to Feeder
❑ Other
❑ Farrow• to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Totai SSLW
9 d Number of Lagoons
"° ° ❑
�., �¢? Subsurface Drsins'Present La oon Ares
❑ S ray Field Area
Holding Ponds / Solid Traps
3
_ ❑ No Liquid Waste Mana ement Svstem
S
E
Discharges g 5tream Imnacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wei, to Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): A4,
❑ Yes FQ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes [!I No
Structure 6
05103101
Continued

Facility Number: — 3
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-5 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
WasteApplication
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
❑ Yes ® No
❑ Yes W No
❑ Yes [�5 No
❑ Yes [Z}No
❑ Yes [�JNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type r3 e-,,. ,r d.4._ & u ,zrr,t n 6 , S .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P 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 QNo
16, Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[allo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[�&No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
r"'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
�SLNo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[&No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Uallo
24. Does facility require a follow-up visit by same agency?
❑ Yes
[21'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
10
Commentsh(refer to'guestion`#) Explain any, YES answerssandlar any recommendatioMns,gory othercomments.Ciaedrawingsofsfaclllfyto
better explain situations. kuse,additional pagCB ns r1 Ce9Sary�CoPv ❑ Final Notes
� ,tea. �❑Field
6 {44--j LA i � e rib Si s--,,��'► � t,S 6. r{,�..L v i
kip IPA �...
Reviewer/Inspector Name ,:. tr:.r"'`
Reviewer/Inspector Signature: f z Date:
05103101 ti Continued

Facility Number: - Date of Inspection
Odor 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, and/or 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?
05103101
❑ Yes ❑ No
❑ Yes [�INo
❑ Yes R No
❑ Yes [&No
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No

Facility Number � Date of Visit: 0 Time: �
Not O erational Belo�Threshold
Permitted ®Certified E3 Conditionalh Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Cz,„ I i ..r_ S tom} r; niL j7w"ky, . t',r.e,- . County: _.. i t J�Ilmn'4 _
Owner Name:--I�_t3._� STD„Y�Q= �7 c� c n Gm 1"a`r Phone No: �[_T e�_ t7.0
Mailing Address: 1 C' e ina C to l C"C t d—n ., iys C. fob
Facility Contact: ___- Aac. ul a Az s Title: Phone No:
Onsite Representative: Integrator: _BLS
Certified Operator: it (5w.4 k U nn Crtytrtnn Operator Certification Number: 2ZO40 (ort_S)
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• �� 4J" Longitude �• �DK
Design
Current
Design Current Design Current
Swine Capacity
Population Poultry
Ca acity Po ulation Cattle Capacity Po ulatiou
❑ Wean to Feeder
1
10 Laver
I
I
❑ Dai
❑ Feeder to Finish
I
❑ Non -Laver
❑ Non -Dairy
® Farrow to Wean
o
Foweder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
Q > : ❑ Subsurface Drains Present ❑ La oon Area.im, Spray Field Area
;Holding Ponds I Solid Traps
Management Svstem
Q ❑ No Liquid Waste Mana
Discharges 8- Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 31
05103101
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes RNo
❑ Yes EINo
❑ Yes 12 No
Structure 6
Continued

j
Facility Number: — Date of Inspection c�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IN 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
Waste 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 L, er. . 4. +
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ERNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
MNo
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
N No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[54 No
Reguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[RNo
18.
Does the facility fail to have ail components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
MNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes EZNo
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 fLv"(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
Comments (refer to question #) Explain any YES answers andbr:any recommendations ortany'other comments.`; r
iJse, drawings2of facilito`k►etter explain situations. ty (use additional s pages as necessary) ` z ^ '
�5 ❑ Field Copy ❑ Final Notes
F=6'r v►.) rc on rd +- I �p 61 _&A act
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility Number: —tDate of Inspection a C
Odor Lssues
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.c, residue on neighboring vegetation, asphalt,
roads, building structure, and/or 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?
05103101
.ryes ❑ No
❑ Yes [jO No
❑ Yes E'No
❑ Yes R No
❑ Yes ® No
❑ Yes No
Yes ❑ No

1I...Pow,..ylH7 tea.-. ,�-:,'S$'c. •F- .5:, •.i�r'Saa.'.]F.:r. x.. rr4-..!IT,-....-.:.�.', .<.r./....a-.,-., —. •• --N .All --..:. 5'- i1-11,-_,..: 3_---V «..'.4 F.. Y.+F
jO Routine O 2.mElaint C Follow-up f DWQ inspection O Follow-up of DSWC review OrOther
Facility Number Date of Inspection Z"
Time of Inspection : t'I� 24 hr. (hh:mm)
Permitted [3 Certified © Conditionally Certified 0 Registered Q Not Operational I Date Last Of erated: ..'.
Farm Name ...... cretrabl.&a l` MWA ... ......�QY.:%M..,�. ........... County:.......... ,C�LNc. ......................
...
Owner Name:...1'`?es....., , ". ..1./ ..� 7......... Phone No:........•.•..............�.f1..��.................................•..•.
Z
Facility Contact:.:.....M.a. .......e.s....................... Title:.........!......................... Phone No:..................................................
.Mailing Address:.•.................................................................•.................•.•...............•..,..•.•....• .
OnsiteRepresentative: ............................................................ l .............................................. Integrator: ................. ,C�i. l..i................ I........................
Certified Operator , Operator Certification Number: ................
Location of Farm:
Latitude =• =, C- 11 Longitude =' =, 01:
Designtf�,fiCurrentT`
Design Current d s' Design -Current
S►nne r,, ,,.•, .,
Ca acet Poultry
,...:
Ca` acif : Pa ulation Cattle Po
„ .7Po
ulation°
•.; „Ca act .r ulation
❑ Wean to Feeder
❑ Layer
[:]Dairy
❑ Feeder to Finish
�: ❑ Non -Layer
- ❑ Non -Dairy
Farrow. to Wean
❑ Farrow to Feeder
❑OtherV;
'
:•
❑ Farrow to Finish
Total Design Capacity'
❑ Gilts
❑ Boars
Total SSLW
�.
Num6er of Lagoons %•
❑Subsurface Drains Present [2❑ Lagoon Area Spray FiX.eld Area
r4r w ,. . .
A
Holdinj Ponds L Sohd;TFaps:r;
n No
Liquid Waste iVlanaeement System r afN .. :.,'• . ' .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man made''
b. If discharge is observed, did it reach Water of the State? (Il'yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure: 5
❑ Yes ❑ No
❑ Yes Cl No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
[]Yes ❑ No
❑ Yes XNo
Structure G
Identifier: ��%%
...
Freehriard (inches): .........Ys ...............................................
.................................... ................................... ......... I......................... ............. I.....................
5. Are there any x
*-� seepage, etc.) hrea to t tegrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [:3 No
3/23/99 Continued on back
I