820059_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Q-Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: V xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
I .
Date of Visit: 1,20Atft Arrival Time: Departure Time: County:
Farm Name: �i L�4- d xG B 1 d✓`—Owner Email:
Owner Name: 1( Phone:
Mailing Address:
Physical Address:
Facility Contact: CIv w � C. BV'WYGI Title:
Onsite Representative:
Certified Operator: c,^ice`
Back-up Operator:
Location of Farm:
Latitude:
Region: F4D-
Phone:
Integrator: rv`r{�Lq�
Certification Number: 16 7.51
1
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish:1
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
11-ayer
I
Dairy Cow
��
Non -La er
Dairy Calf
Dairy Heifer
D Cow
/s
_11f 0
Design Curren#
Dr. Aoultr. Ca i op.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
©ther Turkey Poults
Other 101 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? (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 [D"No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[`NA ❑ NE
OINA ❑ NE
❑ Yes
❑ No
Q'1GA
❑ NE
❑ Yes
D No
[] NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: - Date of Inspection: 90
Waste'Colletc on & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ -Ni3 ❑ NA D NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑'1 IAA ❑ 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 �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes M- o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C "o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E�`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [i] No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift N ❑ Application Outside of Approved Area
12. Crop Type(s): l`' Z1_V_ 1 V c'7 r�CJ'Ni J'� I i�i7 ]
❑ NE
13. Soil Type(s): _ I p Mr,,A 0 y I4
14. Do the receiving crops differ from those designated m the CAWMP?
❑ Yes
FIX8
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E]Xo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'l o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q- -o
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
to
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
E:rNo
❑ 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
[31�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[E�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 21412015 Continued

Faciii Number: jDate of Ins ection: vl
24. Did -the faeiiity fail to calibrate waste application equipment as required by the permit? ❑ Yes CEI-IG
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 2_�o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ET'N—o
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[ErNo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes
C3 o
❑ NA
❑ NE
❑ Yes [2'/&o
[] Yes �No
❑ Yes [] No
❑ NA ❑ NE
[] NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: a Date: Lo 44t- `
Page 3 of 3 2/4/2015

-Division of Water Resources
w ' Facility Number - l�J O Division of Soil and Water Conservation
O Other Agency
Type of Visits `ompliance inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: p t' Arrival Time: Departure Time:® County: Region:
Farm Name: Th6�.� ,L(t(t(it«� Owner Email:
Owner Name: yVrtr� l n 4m Phone:
Mailing Address:
Physical Address:
Facility Contact: _ C '� S &eyicck Title:
Onsite Representative: k
Certified Operator: -cfAI&it
Phone:
Certification Number: ' 1
Integrator:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
O �oI jNon-Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry C'anaeitV Pon.
Layers
Non -Layers
Pullets
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'? (Il'yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes D Ko' ❑ NA ❑ NE
❑ Yes ❑ No E "NA ❑ NE
❑ Yes [:]No ❑iNA ❑ NE
❑ Yes
❑ No
ff NA
❑ NE
[:]Yes
� No
❑ NA
❑ NE
❑ Yes
0No
[DNA
❑ NE
Page 1 of 3 21412015 Continued

Facilrt Number: KA- Date of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9-No`
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[31TA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are4here any immediate threats to the integrity of any of the structures observed?
❑ Yes
ER17o
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. 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
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
["No
[] NA
[] NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C? No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0 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): eJ S Fes] Q7_ (!5u
13. Soil Type(s): /U0 Wp`,, q
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E]/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNO
o
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
[] NA ❑ NE
Page 2 of 3 21412015 Continued

FacilK Number: Date of Inspection: It /0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E ' o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D<0
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 ❑'lQ'o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EJ No
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
F"TNo
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
[3-,No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes
�No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E!fNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[7�No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
eNo
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any addition al:.recommendations or: anyother comments.
Use drawings of facility to better ex lain situations (use additional pages as necessary).
SL�tscY 19-4-1�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
D- 9(3 �-?-,7
Phone: m—mq
Date: 10 "Lri
21412015

V�[�V+ s
M
WDivision of Water Quality
• Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: i;�r"Compliance Inspection Q Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up 0 Referral O Emergency O Other Q Denied Access //�
Date of Visit: Arrival Time: Departure Time: County: �t��11Regio'-r
Farm Name: 1�1. �3`Y Q r�G �LCiI` 00ivner Email:
Owner Name: Ct Phone:
Mailing Address:
Physical Address:
Facility Contact:
&43 (Q61LG cTA Title:
Onsite Representative:
�+
Certified Operator: �V'�.t`y � 1ti D V K41",
Back-up Operator:
Location of Farm:
Swine
Latitude:
Integrator:
Phone:
Certification Number: `'U �s(
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er I I ::::]
U on -Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
wto
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Nan-L.
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
. 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)
e. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Eg<o ❑ NA ❑ NE
❑ Yes
❑ No
❑'NA
❑ NE
❑ Yes
❑ No
❑-IQ'A
❑ NE
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
❑ Yes rlNo
NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Page 1 of 3 21412011 Continued

Faciii Number: - Date of Ins ection: q
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ ] No
E540r
❑ 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
EhS'
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2-11o_
❑ 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
[]goK8
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ 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
[20Mo
❑ 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 �lo ❑ 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): � 3 G O `�[J�.�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWl"P?
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 [�lo ❑ NA ❑ NE
❑ Yes �Ko ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes Elo
❑ Yes E No
❑ NA ❑ NE
❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available? [—]Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: it
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CJ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility 'lumber: _ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes R<O ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ 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 dNo ❑ 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 E!rNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 Signature:
Page 3 of 3
❑ Yes dNo
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ZoNo ❑ NA ❑ NE
[—]Yes VN
❑NA ❑ NE
Yes ❑ NA ❑ NE
I ILVII .. ♦ -i J urJ J l
Date: �0
21412 14

t2IIm rt -I q ft'A r s
Z. C9'Division of Water Quality
Facility Number - 00 �C 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ��omn�pliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit:t9�'ltoutine Q Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: tr o0 Departure Time: FR r 5 r I County: Region4F(4 J
Farm Name: jL0 f e) r+ti Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r_V,u)LS13 g V-CV Title: Phone:
Onsite Representative: ' Integrator: f L .Q
Certified Operator: Certification Number: i % 7 S 1
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Sly DO I I �j
Wean to Finish
Wean to Feeder
Feeder to Finish
1d
ZW
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Dry t'outtry
Lamers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Design Current
Cattle Capacity Pop.
Dairy Cow
Daily Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Bcef Brood Cow
❑ Yes [Z�oKo ❑ NA ❑ NE
[] Yes ❑ No [�,IQA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[31NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
dNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[]Yes
[2'1�o
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
P `"o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o —❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [ ❑ 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?
(i.e„ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes io ❑ NA ❑ NE
❑ Yes �lo ❑ 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 [3 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [__,Ko ❑ 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 Cn '''o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ Vo ❑ 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): NCyt �t.7� �i(�IJQ f wli D
13. Soil Type(s): _ Vp j( v od
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
[o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ 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 6 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 InspectioZ.No
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Date of inspection
24. Did the facility fail to calibrate waste application equipment as required by the pe it? ❑ Yes Q-ND
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge'? ❑ Yes �10
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Erl�o
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?
to
Use drawings of facilli
Ci.['b Vvik M k
g(jij,�
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E�N_o ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes 5No ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes
❑ Yes dNo
❑ Yes CJ No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
stion #): Explain any YES answers and/or any additional recommendations or any other comet
to better explain situations (use additional pales as necessary):
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
13- k e-- l q
Phone: te,3 -s 3 V
Date: L-S Miet
21412011

ass s A
ck N bf)
15-UrvTslon of Water Quality
Facility Number - d Division of Soil and Water Conse
rvation
Q Other Agency
Type of Visit: V00utine
nee Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up Q Referral C) Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: c Departure Time: I County: Region: Fez
Farm NameOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: cu,-,-�� -w t"" ( Title:
Onsite Representative: CC
Certified Operator: - VA &
Phone:
Integrator:
Certification Number: b
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: Longitude:
Design CurrentDesign Current
Capacity Pop. Wet -Poultry Capacity . Pop.
Layer
O� t7 Non -Layer
pry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
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)?
Design Current
Cattle Capacity Pop.
Dai Cow
DaiLy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �o _ ❑ NA ❑ NE
❑ Yes ❑ No K -M ❑ NE
❑ Yes ❑ No C?I-'NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No ❑i' I�A ❑ NE
2. Is there evidence of a past discharge, from any part of the operation? ❑ Yes I-Y""' ❑ 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 21412011 Continued

• Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
CS-110
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3.3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[&Ko—
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[]'o
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[DAo
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
©-<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
1 'V U
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑`�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [T 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 Lure Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):':L06,642-5-15 kin
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[BNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�lo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
2""'
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
to
[] NA
❑ NE
Required Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F3/N o
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [I 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 Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ef'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[3 NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [4'ITo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes tg""' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 02,N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 13-<o NA ❑ NE
Other Issues ��
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C344 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes L- Wo ❑ NA ❑ NE
❑ Yes [T No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[3Io ❑ NA ❑ NE
E .o ❑NA ❑NE
F/ No ❑ NA ❑ NE
[j 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).
o
Reviewer/Inspector Name:
Pho
Reviewer/Inspector Signature: Date: LJh�
Page 3 of 3 2141201

Divislon � of Water Quality 0—o
Y Facility Number ®- ® O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: .��ommpliance Inspection Operation Review p Structure Evaluation p Technical Assistance
11 Reason for Visit: xoutine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I — /�- Arrival Time: O a Departure Time: 30 County; 5�'=_ Region: �-
Farm Name: 7 K, oe-4b_ r �,j C3 ®L�t Owner Email: �—
Owner Name: /\.Zb _ 19CK-Phone:
Mailing Address:
Physical Address:
Facility Contact: !.c/ /+3 ��X�' t1k Title: tie _
Onsite Representative:
Certified Operator: t a �^--
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator: piei'
Certification Number: Z,j f
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
a 00
I INon-Layer_
Wean to Finish
Wean to Feeder
Feeder to Finish
i a
08
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Non-L;
Pullets
Other
Pouets
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)?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [E 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

Iracili Number: - Date of Inspection: —
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 25 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): —3Q j
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
'® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
;� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IM No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rNo ❑ 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): G I rt 120 k RiK p Z LLJ-14
13. Soil Type(s): 1V,0 /(rp,Z t/ ANIZ, _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes to No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [S No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes S1 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 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
r No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P"No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Wacility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Jam+. Yes Rf#ot ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
59Non-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 S No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MI 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)
3 I. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JgNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:} Yes [Z No 0 NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
[—]Yes ® No
❑ Yes ,� No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #}: Explain any YES answers and/or any additional recommendations or any other comments.
Use'drawings of facility to better explain situations (use additional pages as necessary). "
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone: 9 a—y.3�3�c�o
Date: =A70 13
21412011

Type of Visit: Co Hance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: I V1_1Z Departure Time: tam M County: q� Region: n%
Farm Name:���y1.�cy^ F >ARY,,S_ts (1lp "p ) Owner Email:
Owner Name:,�p�R� �[���{�� Phone:
Mailing Address:
Physical Address:
Facility Contact: LU—m- ,7zQRw' QJ� Title: Phone:,
Onsite Representative: sMt Integrator:
Certified Operator: L, �.SZp�c ­(hQZ1\4c9 i�) Certification Number: ?�S]
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.Im
Design C*urrent Design Current
Wet Poultry Capacity Pop, C►attle Capacity Pop.
Wean to Finish
I
17None-Layer
r
DairyCow
Wean to Feeder
a��Q
1
Dairy Calf
Feeder to Finish
y v
Design Current
l)r¢ Poultr> . ; .. VaRnel Pop...Mi.
Dairy Heifer
Farrow to Wean
f,„
Dry Cow
Farrow to Feeder
Non-Dair
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
t
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
FTTurkey
Poults
Other
I
I Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 4o ❑ NA ❑ NE
❑ Yes
❑ No
[ "NA
❑ NE
❑ Yes
❑ No
ETNA
❑ NE
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ) ❑ Yes ❑ No OG NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [gNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes YNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

r +
Facili Number: 9 - Date of Inspection: LAI Ai )Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ffNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: +W I -
Spillway?:
Designed Freeboard (in): t
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Vr 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 CE�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 Cg'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 [TNo
❑ 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 [ o
❑ NA
❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Rll�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 'No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
5�^o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
[2"'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ 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 [jrNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�(No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
2rNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - S Date of Inspection: gILkl%-Q
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 E3 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit'? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a 11ollow-up visit by the same agency?
❑ Yes S211140 ❑ NA ❑ NE
[:]Yes YNo ❑ NA ❑ NE
❑ Yes [O"'No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
EZNo
❑ NA
❑ NE
[] Yes
VNo
❑ NA
❑ NE
❑ Yes
Cj�<o
❑ NA
❑ NE
❑ Yes
G5Ao
❑ NA
❑ NE
[:]Yes
VNo
❑ NA
❑ NE
Comments refer to q p y,. y dditiona y ( uestio0'0t. Ex Ihin an ES answers and/or an a l recommendations Or an other comments
Use drawings of facility to.be.tter explain situations:(use.additional pages as necessary).:
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
6
,1
r -
Phone:
Date:
21412011

31 m s 6113,111
Type of Visit: E�r`Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 01 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 'p Departure Time: �S County: Region: �FC�
Farm Name: _4UWi4m. k�f'D r�P K" Owner Email:
Owner Name: V`ppr-�— �'Phone:
Mailing Address:
Physical Address:
Facility Contact:Zaf-&JkL.�_LTitle: Phone:
On site Representative: 1:SzIntegrator:
Certified Operator: nn Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capaclty Pop.
Wet Poultry
Capacity Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder O
Non -Layer
Dairy Calf
Feeder to Finish T1Dai
Heifer
Farrow to Wean
Design Currents
Dry Cow
Farrow to Feeder
Dr, E..Poultr,,t
Cu"aciPo�r
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
=
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other I
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ffNo ❑ NA ❑ NE
[:]Yes
[:]No
IAA
❑ NE
❑ Yes
❑ No
l NA
[] NE
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 Ej`No
❑ Yes 2 <0
iA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes To ❑ 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 PIC' ❑ 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 to ❑ 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 E3*No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E3 i�o ❑ 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 0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D<o ❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? C] Yes [V]'fvo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E3 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes jf'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 02<0 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Q No ❑ NA ❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E
❑ 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.
❑ W1.1P ❑ Check] ists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑' o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'N`5"_
❑ NA M NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ Na
gKA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm/ ❑ Yes &ErNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 020<o [DNA ❑ 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 [T N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 2 l�A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [Dlo ❑ NA ❑ NE
❑ Yes C10 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes B o ❑ NA ❑ NE
❑ Yes [Rr�o
❑ Yes g2of4o
❑ Yes [2'<o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
1C.bmments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
§e dri3win�s;;of,facility to better explain situations (use additional pages'as necessary}.AN
Reviewer/Inspector
Reviewer/Inspector
Page 3 of 3
Phone: 6KL���
Date:
21412011

,B.zwS :2 - 05 - z o! V
Type of Visit
ompilance Inspection
Q Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit
(Q'ifo—utine Q Complaint
Q Follow up Q Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: I-Zq- /0 Arrival Time: Departure Time: II r 30 County: ,s2tn 2Sy" Region:
Farm Name: 1 7-1 o r ,&A/ 6 id.Fc-,.'owner Email:
Owner Name: � 7_kb k-fJ Y-on.! Phone:
Mailing Address:
Physical Address:
Facility Contact: _Lu v al ig9cY�s I'c_ +- Title: �{�� S� 0-' '7--- Phone No:
Onsite Representative: I Integrator: li (1a 6- r A fu.v ��-
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
FAV
Latitude: ❑ 0 0 d Longitude: = ° =, =
Design Current
Design
Current Design Current
Swine C•apacciity Pupulation
�F'et Poultry Capes tty
Population Cattle Capacity Population
El Wean to Finish ❑ Layer
El Dairy Cow -
can to Feeder Z 6a 12360 on -Layer I
❑ Dairy Calf
❑ Feeder to Finish /D
❑ Dairy Heifer
❑ Farrow to Wean Ury Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish ❑ Layers
❑ Non -La ers
❑ Beef Stocker
❑ Gilts
ElBeef Feeder
Pulle
❑ Boars ❑
❑ Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
❑ Other I ❑ Other
Number of Structures:
I
Discharizes & 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 past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
B<A
❑ NE
❑ Yes
❑ No
9 A
❑ NE
BNA
❑ NE
❑ Yes
❑ No
❑ Yes
©-K-o'❑
NA
❑ NE
❑ Yes
Q'Ko'�
❑ NA
❑ NE
12128104 Continued

Facility Number: 8,2—� 9
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
EYNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Io ❑ NA ❑ NE
Structure Structure® Structure 3 Structure 4
Structure
5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in): Ldteo" pAie-v-"f4oi —4-e�011
Observed Freeboard (in): Z Z— Z Z
5. Are there any immediate threats to the integrity of any of the structures observed'?
El Yes
,/
E o ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which arc not properly addressed and/or managed
❑ Yes
2<o ❑ 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
E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
l- K ❑ 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
/
B ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application`? If yes, check the appropriate box below.
ElLiYes
,. ,
"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 Drill ❑ Application Outside of Area
12. Crop type(s) �$ww• a. 4�wC�t-oi e J 1,-,1/6ra,
13. Soil type(s) A6 A K p 13 mas— 11 L- j w�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ YesNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
ElYes
2/No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
es. No
El NA
[I NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
2 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
� i�
fer to': uestion # : Ex lain any YES Answers and/or any recommendationslor any othcr,i,comm Comments {re tf ) p euts
i.lse drawings of facilitv`tu better explain situations. (use additional pages as necessary)
Reviewer/Inspector ector Name _'"u"
p /:G �v�tN 5g; ! Rhone: /a, �{33 .336 O
Reviewer/Inspector Signature: Date: /—L9-- 2-01 D
12128104 Continued

JI �
Facility Number: V2 --59 Date of Inspection I- 2 y' 1O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 8 No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&<o
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
//
9 o
❑ 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
Bio
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fio
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[IYes
D No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0- o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LUG, o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
LTNo
❑ NA
❑ NE
Other Issues .-,!
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes [3 tvo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0<
❑ 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
/
B 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
El Yes
,.,,�
L7 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
B<
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Lf No
❑ NA ❑ NE
12128104

E r444 5 /o -oS 2-0 09
%,—Division of water Quality
Facility Number 8�� sq 0 Division of Soil and Water Conservation
Q Other Ageney
Type of Visit OIC-6-m-pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
y Reason for Visitfoutine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: //Q Arrival Time: /0 �/s Departure Time: 0,�,�� County: .Sa^�A-5'on/ Region: ITRO
Farm Name: -2 ?% E,+ A*;Pr,,re,5' Owner Email:
Owner Name:_ _ Rc26er�- -TGtor-"4or`r Phone:
Mailing Address:
Physical Address: /o
Facility Contact: L� ar-4fS 'Title: _ �� • SPA-' Phone No:
Onsite Representative: Integrator: Co e.. A +-m.S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I ❑ Longitude: = ° ❑ 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La y er
$00 Z ❑ Non -Layer
❑ Wean to Finish
21vean Feeder
�eeder to Finish
/D
56
❑ Farrow to Wean
ElFarrow to Feeder
ElFarrow to Finish
ElGiits
❑ Boars
Other
❑ Other---- -- -�
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: [Ell
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 BNo ❑ NA ❑ NE
❑ Yes
t-TKo
[ NA
❑ NE
❑ Yes
❑ No
2<A
❑ NE
B A
❑ NE
❑ Yes
❑ No
❑ Yes
8'1�o
❑ NA
❑ NE
❑ Yes
[lfo
❑ NA
❑ NE
12128104 Continued

1 ►
Facility Number: S2 — 5d7
Date of Inspection 9-/7`0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZB_I
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes LI No ❑ NA ❑ NE
❑ Yes ammo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 3-go ❑ NA ❑ NE
❑ Yes BIT& ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®- o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes G17b ❑ 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 B1,0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (7 c- ' w d a,_ (6 -r, T e) Sri l G'►. nr ( 00 s, W i u fir
13. Soiltype(s) Ala , AlpFS MOIC (A)aw8
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EYNO"'
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[:,oo
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
69"'N'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
l_3'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10
❑ NA
❑ NE
Reviewerllnspector Name�� "f
�%f! Phone: ' /a
ectar Signature:�
Reviewer/Ens
R IPidG 2 /Q i— Date:
12128104 Continued

Facility Number: 82 - 59 1 Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETIZ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CTNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p 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 V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[R o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E31N'o
[I NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,3,
L,.�'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[J No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
13<0
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2lo
❑ 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
,_/
2 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
[3 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Oo
❑ NA
❑ NE
12128104

.B�Z,IS 2 -O y—Z O/O
Facility Number SZ I
ivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
& outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: /D;® Departure Time: `/� County:
Farm Name: I�NUZ6 A.'Ve. _a V;; l Owner Email:
If
Owner Name: A1,6— IlGprwg Phone:
Mailing Address:
Region: IMVW
Physical Address:
Facility Contact: ae k5 —Title: 7 ec , S e L1 Phone No:
Onsite Representative: Integrator: alw 1'< < / 7►'M S
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Design Current
swine Uapacity ropulanon
❑ Wean to Finish
❑Wan to Feeder
Bf-eeder Finish 9& 1 4192-7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
Boars
Other
❑ Other _ - — ------ —�
Latitude: 0 0 =' = ` Longitude: 0 o 0' 0 "
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DaiEy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 501
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 Eil o ❑ NA ❑ NE
❑ Yes
❑ No
[5-1gA
❑ NE
❑ Yes
❑ No
QIlA
❑ NE
lA
❑ NE
❑ Yes
❑ No
❑ Yes
0�
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
12128104 Continued

I Facility Number: $2 — &/ I Date of Inspection
Waste Collection & Treatment
,__,,,,,//
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
L7No
❑ NA ❑ NE
a. If yes, is waste eve[ into the structural freeboard?
❑ Yes
DNo
El NA El NE
6
Structut� Structured Structure 3 Structure 4
Structure
5
Structure
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z Z �'
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
fo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[4-11o'�
❑ 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
Io
❑ 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
3<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CTNo
[]NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
ETNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Z,t, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Rare Soil
❑ Outside of Acceptable Crop Window ❑ of Wind Drift [:]Application Outside
of Area
,lEvidence
12. Crop type(s) U i[��• tea �'4 e� f SG,� c[ �x r,aaf�cl �o , S
Sa+ti •4W ��. /r� �✓ A,mu c�S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ER<o
El NA
El NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
o
[I NA
[I NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?
❑ Yes
,[��,'
I� hio
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
B'Iqo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
ff No
❑ NA
❑ NE
tiComrn fits (refer to question fl Explaid any YES answers and/or any recommendations or any other comments
;Use drawjngs,'of facility to better explain situations. (use additional' pages as necessary):
n,aT�.dC.�FaiJF!.
Reviewer/Inspector Name I Rj K ' Reev�ls I Phone: 9/0, �_ 3, 330 o
Reviewer/Inspector Signature: Date: Z —O I —ZO1 O
12128104 Continued

w 1�ak
Facility Number: 2 — Date of Inspection 2 `4 — /
-51
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 L`1No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Mans [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspection,.s,.,,�❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(B o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
tom(' No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
oo
[I3 NA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El3 Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[B o
❑ 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
<o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
00
❑ 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
M<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

812, 9108 v-r
)ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit GMfoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 8-'/.3'Og Arrival Time: �,' S Departure Time: ,% County: Y1?2t _Vb d Region: j2U
Farm Name: _TA0 t^�-�Cn/ 64,�-4k'3J V t/O%d �tyi.�f Owner Email:
Owner Name: Robev-+ �1DYnib n/ Phone:
Mailing Address:
Physical Address:
Facility Contact: �.taV41—S gTitle: 7Z:,/-. Zee,,_ i �+ Phone No:
Onsite Representative: �i�is erN�dnl Integrator: t 0A6t Vi�C. /tea ma r S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
=o =I =1 g =0=6 =I&
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
ZJrd 0 Z 5'1?-5 ❑ Non -Layer
❑ Wean to Finish
NJ Wean to Feeder
® Feeder to Finish
Q
❑ Farrow to Wean
ElFarrow to Feeder
ElFarrow to Finish
ElGilts
[IBoars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
ElPullets
LiTurkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Daia Cow
El Dairy Calf
El DaiEX Heifer
El Da Cow
ElNon-Dair
ElBeef Stocker
ElBeef Feeder
ElBeef 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 ' No ❑ NA ❑ NE
❑ Yes
❑ No
Q'�A
❑ NE
❑ Yes
❑ No
[ NA
❑ NE
ErNA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
ETNA
❑ NE
❑ Yes
❑ No
0<A
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:
Date of Inspection 16 -13-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ENNo
❑ Yes E no
Structure 5
❑ NA ❑ NE
❑NA ❑NE
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 eNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [3 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 ,L_7, N/o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes L� 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 Do ❑ NA ❑ NE
maintenance or improvement?
Waste Annlicatio
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L3No ❑ NA ❑ NE
maintenance/improvement? �,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElL2
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 A
12. Crop typeVs) e 'Mu rica_ 11,6k- .-gt ) SirW11/l4-rnlAl /0, 5d . _5VW , 1 � 4J,.A 4., 4VA1JJ (D rlV
13.
Soil type(s) ItlaA .Wag, /Vag _ Aae
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L_I No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
20No
❑ 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
E No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L3 o.
❑ NA
❑ NE
Reviewer/Inspector Name ^ i:;�lv Phone: ��O• �f 3 3.3 U
Reviewer/Inspector Signature: Date:— /3 Z 0 O gJ
Page 2 of 3 12128104 Continued

Facility Number: ?Z 1 Date of Inspection i3—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3lo ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B rvo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
[:]Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ <o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑-<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 3<o ❑ NA ❑ NE
Other Issues /
28. Were anv additional problems noted which cause non-compliance of the hermit or CAWMP? [I Yes B o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 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?
Cl0 Yes
❑ 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
[ Flo
❑ 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
B o
❑ NA
❑ NE
Page 3 of 3 12128104

® Division of Water Quality
Facility Number 8Z s Q Division of Soil and Water Conservation -:
;Other Agency`
Type of Visit ® Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit (fil Routine O Complaint O Foliow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: o- p g- D 7 Arrival Time: Departure Time: 9
Farm Name: / �[1rNn/�F,Nr
OwnerName:�k_�_ /`lo�,whn/
Mailing Address:
01-1 County: SkwDSonl Region: AM
Owner Email:
Phone:
Physical Address:
Facility Contact: _r_U$'1 S lrLki, Ac'k_ Title: h�vil, Alcy Phone No:
Onsite Representative: CLl ✓t1:5 �uyw�'�k ^_ Integrator: LQ�•atri Fa v
Certified Operator:
Back-up Operator:
Location of Farm. -
Swine
Operator Certification Number:
Back-up Certification Number:
=o
Latitude: Longitude: =o=6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
1J �� ❑ Non -Layer
❑
Wean to Finish
®
Wean to Feeder
[A
Feeder to Finish
/Q
z $Z
❑
Farrow to Wean
❑
Farrow to Feeder
El
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
El 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 Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
❑ DairyHeifet
El Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
El 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 [� No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[R No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128104 Continued

Facility Number:'72 —S-9 I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 j
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes 6No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? r
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V1 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
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
+I
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
;Comments (refer to ,question #) ; Explain -any YES. answers and/or any recommendations�or any other�comments
,Use drawings of facility ,to better explain situations: (use additional pages as necessary}: ,h
�Ok C& 14 a IJ s� Cr `M-o Ch"4-n 5"i-AIt Taf iirl) 5 G? 1r� �i ✓ 5 0/�%
�7'i�-f� .�wP 1Z
Of ► ?,.w L�V- i S t4 i m
Reviewer/Inspector Name I R fc, E 21e JL�S V - Phone:
't�/a 4V'U.13a -0
Reviewer/Inspector Signature: Q...a�y Date:
to -Qoo— Zo o —%
Page 2 of'3 12128104 Continued

A . =r
Facility Number: IF2 - E2 Date of Inspection
Reduired 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 appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other I
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 q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [A No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ ] No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q?No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
° No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
14 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

� Division of Water Quslity
==Number '�Z 59 ivision of Soil and Water Ctrnservatlon
� ©thcr Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: _-jfd Arrival Time: �: s Departure `Time: County: ���� Region:
Farm21
Name: V YA-1 0^/ 0"A174ea , re- 6. d 6'Q Owner Email:
Owner Name: *4 Otoe�v+" ::Qia ra-h n/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Abe -Thor Title:
Onsite Representative: Cok-b 5 S�i�✓��-k
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Integrator:
Phone No: -.._
Co rya, —I L
Operator Certification Number:
Back-up Certification Number:
❑o =, � =o =1 � 14
Latitude: Longitude:
Design Current' Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
Z 500 2 330 ❑ Non -Layer
❑
Wean to Finish
Wean to Feeder
®
Feeder to Finish
/0
Z S D
❑
Farrow to Wean
❑
Farrow to Feeder
El
Farrow to Finish
❑
Gilts
El
Boars
Other
❑ Other I
Dry Poultry '
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
❑ Turke 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 Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: �I
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 Z No ❑ NA ❑ NE
❑ Yes
[�j No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
NNo
❑ Yes
tO No
❑ NA
❑ NE
❑ Yes
�R No
❑ NA
❑ NE
12128104 Continued

Fecility Number: Date of Inspection S O—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes (S No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes '[�rNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes %No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[9No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[!�No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C%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) r �---
` I
13. Soil type(s)%Gi y YCtttit J�/%aYV �l /� . �o reb 11C
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, Ej Yes
rfll No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/inspector ector Name "� a `.. `�«r K}rw �btT 'yj' c��.G fw _
p �, .�, % f,f , utl S u: ! : k :R1yl d u { r?r4 � 1.xks6 Phone: �o� �S� YlS4//
Reviewer/inspector Signature: tv�✓ Date: S— /Q — Zoo_iP
12128104 Continued

Facility Number: FrZ — 5"} Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropiate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VO No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R1 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ 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
PrNo
❑ 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
(U No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�fNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
12128104

50
Type of Visit 0 Compllance 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 ❑ Denied Access
Date of Visit: Arrival Time: �' ,3r, Departure'rime: County: $��Y' �Q!— Region: FO-0
Farm Name: ^ Z� _ �� n 6A-WW jig ­ (d 14 Fes. Owner Email:
Owner Name: ab r c 13 �o M ley TI+o�„L-ENIr+ Phone:
Mailing Address:
Physical Address: 3•'1 S y ref /W CCc. 1 �c v doe C%.:t. rN� lV C
Facility Contact:
Title:
Onsite Representative: ir'w n i Q Tkn fm tnk�
Certified Operator: (t r T� �,_r_wr_+D of
Back-up Operator:
Phone No:
Integrator: co
Operator Certification Number: _% 4-7-5-1
Back-up Certification Number:
Location of Farm: Latitude: Lon 0 0 = ` = " Longitude: = o = 4 0 "
Design
Current
Design Current Design Current
Swine
Capa�crty
Population
Wet Poultry
Capacity Population Cattle Capacity `Pyopulation
❑ Wean to Finish
❑ Layer ==
I , ❑ Dairy Cow
© Wean to Feeder
,So:,
' Sp i
❑ Non -La et
3 ❑ Dairy -Calf
® Feeder to Finish
yy/0
y3 9 0
, ❑ Dairy Heifer f"
❑ Farrow to Wean
#
r k„k k4�f Z ❑ D Cow
Dr Poultr in
El Farrow to Feeder
�;sxy ,F y s ...�a r .., ; } M.iE ❑ Non -Dairy
ElLayers
❑ Farrow to Finish
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
[SrNo
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? {If yes, notify DWQ}
El Yes
❑ No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (]f yes, notify DVI'Q)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
El Yes
®No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
R] No
❑ 1\TA
❑ NE
other than -from a discharge?
11/18/04
Continued

t
Facility Nut fiber: got — S-`i Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
MV
❑ 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): „"?O, I 5'- s - 95-
Observed Freeboard (in): OIL
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes m No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes V No ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding N 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) , S p.
13. Soil type(s) IVOrn)\/a ti� l lc
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
I t G cS v` -% C U 0% CR YYA a, Y) a VJ +ti e v z >1 c a
c)Ycr .2VC, 000 a 4:6%1 .i PZ * Aart Ptelt,e. SlptGr-� .tf} irk �le.cru Ia.1s�L ret�C•sct
ra+c,
7-) SCro+C ir.+al1 t Gaki OK �c9ii�G 3c�u.�.�.�.'S ivi-+J a+t-oe. ''k-ra—pe- �v.li Pt t' hca.c4q-i.
'`� plf 0, nC C[K'C p� .
Reviewer/inspector Name '+ ` ...._fi "" ff" o iL �XV
« Phone: S/ f /
Reviewer/inspector Signature: Date:
12128104 Continued

ti
Faci#ity Nuittber: 9 — Sg Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (1 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 Z No ❑ NA 12 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
[:1 NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(R] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge`?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CO 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
50 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
AdditionalaComtnents;and/or Drawii s r t ._.P .s3-.i.� '. 9•:�d+- 1. ..:.k
5 c> i ( 5.a' piece h c v'.
6 cL (, L 4 C.Ar . Tin e• e- u r c
bee►., +,,,IGele, ) bk+' t`ke_ r-caL�1#.% a,,z vlot
�O w 04' y e ete'.
12128104

Type of Visit G<ompliance In tion Q Operation Review O Lagoon Evaluation
Reason for Visit O� utine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
FIDate of Visit: 3 .� o Time: � 30
Facility Number
Not Operational O .Below Threshold
M-P'�tted EK'e ed `0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: ... ! +?... "! ^!�................................................................ County: .........S.....................................................
OwnerName: .....cn�.' .... ..L.F!M1j!V............................................................... .. Phone No:.......................................................................................
rZ 5 /'I Grj Ad . 6An fnn as3aoo
MailingAddress:.........'A..�......... _..........�„K.��.............................................................t.....Aj�....................... ... ............................. .....I.".................
Facility Contact: ........L �i ��%tO�Yt` VII
Onsite Representative:.
Certified Operator:,,,,[r,+,r;!!! +tf ►n
Location of Farm:
Title:................................................................ Phone No:...................................................
Integrator: C.....................................................................
Operator Certification Number: ..........................................
L
wine © Poultry ❑ Cattle ❑ horse Latitude • 4 " Longitude • "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [ N6---,
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes aw
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M-N -
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M-no
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................................................................................................................................................................................................
Freeboard (inches): ;1;.
12112103 Continued

FacilityNumber: 0 =
Date of Inspection I 9�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
❑ Yes LSO
❑ Yes Q DW,n
❑ Yes LSO
❑ Yes S-Pe
El Yes l� o
❑ Yes 4Fd____
❑ Yes ON6/
(CAWMP)? ❑ Yes Q�
❑ Yes ELNI--
❑ Yes EaVer'
❑ Yes G2446-�r
❑ Yes 34?6_�
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
�'j 1rCV'1% '�� _4&N..5 40 6e :" V d s110C .
6A*5 }e Gn R �� 5 is �"� 4r A61 b A Lt lea's �rpC� . �f'[ st� S on A w r-) -
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
❑ Yes
❑ Yes RNo
❑ Yes j11 -o _
❑ Yes EINa-
❑ Yes [c�o r
Final Notes
r1)III/M

Facility Number: 4� — Date of Inspection a D
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
mq<
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
�,,�
(ie/ WUP, checklists, design, maps, etc.)
❑
L9'No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
/
M4CO
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[+ 4fr-
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[;piz'�'
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Lea
28.
Does facility require a follow-up visit by same agency?
❑ Yes
2'No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�X�
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L<O
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
®'0
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
1J'flo
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
M4g6'
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
Q, a•
❑ Stocking Form ❑ Crap Yield Form [:]Rainfall []Inspection After 1" Rain
12112103

Site Requires Immediate Attention: No
Facility No. 8 � - Go
aot►' Sg
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ��►� zo , 1995
Time:
Farm Name/Owner: Tko r l%4ge. ntc_r p r s. s Ca 4o
Mailing Address: 3 s z s M, c %-,k1A" 12, A CL N c. -za-3 -z.8
County,. S 4r., i e V
Integrator:_ _ r .e� _ _ _ Phone: Sq z o t os
On Site Representative: Phone: S3%
Physical Address/Location: C_X k 1-Itiz
�C, n' 4F'a.r nti. ors 'r'*21 '
Type of Operation: Swine X Poultry Cattle
Design Capacity: (=q6 % o Number of Animals on Site: (02� l © _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (es or No Actual Freeboard: LA Ft. Inches
Was any seepage observed from the ]nor
n(s)? Yes or No Was any erosion ob rved? Yes or No
Is adequate land available for spray? No Is the cover crop adequate? or No
Crop(s) being utilized: C C o Ll(" m-y-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin o! a or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es r No tust-„%- MN'oN
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management recAs (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y or No
Additional Comments:_ - ,b&&w \—C' 1o'
tour
VA' o, a\ W I CAC a r" W .'Q'L'
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

A rMAL WASTE MANAG22MNT PLAN CBRTIYIGTION FOR NZW OR SPAN = FEELLOTS
please return the colleted form to the Division of Ebmviroamental managaaant at
the address an the reverse side of this form.
Name of farm (Please print)
Address: .2 ,.,,5 Mc--C_�
Phone No.: - 3 7
County: ,3�=..�.. "
Farm location: Latitude and Longitude: o_A'Lf /j - _ (required). Also,
please attach a copy of a county road map with location identified.
Type of operation (swine, layer, dairy, etc.) : 5L.I., v "-
Design capacity (number of animals):_ 'Proo .e a�-,,��`L�
Average size of operation' (12 month population avg.) :,�,,,
Average acreage needed for land application of waste (acres):_ H s.
rasssrrrrrarrrrsrsrrrrrrrrrrrays=rrrrrssrswrrrrrsrrrrrwrwrrsrrrrrrrrsasrrrrrsr
Technical Specialist Certifioatiaa
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to 15A NCAC 6F .0005, I certify that the new or
expanded animal waste management system as installed for the fa= named above
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and water Conservation Commission pursuant to 15A NCAC 2H.0217 and
15A NCAC 6F .0001-.0005. The following e'levents and their corresponding minimum
criteria- hav-e�beer_verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party) ; access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwater runoff events less severe than the 25-year, 24-hour
storm.
Name of Technical specialist (Please Print):--, ur' -"�c,rK f_ K
Affiliation: C< is -.•�
Address (Agency) : ' ' > 'v Phone No.
Signature: _ /�_�-X•--- —'�/ Date: 5 -Y5
rrrrrsrrrrsrrarrr�rrrrrrrrrrrrrrrrrsrrrrrrsrrrrrrrrrrrrsrrarrrrrrrrrsr
Owa+r/Haaager Agreement
I (we) understand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures. I (we) know that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the 'Division of
Environmental Management before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25-year, 24-hour storm. The
approved plan will be filed at the farm and at the office,of the local Soil and
Water Conservation District.
,4Name of er (P1 as rint):�f'ID!"N �17� G,��riJ t.'SCS �
�
e4, •--_ G
Signature:, ��.?��y ,�,�A_., Date:
Name of Kaaagar, if different from owner (please print):
Signature: - ,._. - _- o Date:
X2U: A change in land ownership requires notification or .a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer.
1 DEM USE ONLY:ACNEWN
A� cA %",5 _' T!z f_ 70 ri", C I r " 140K Z TNrh 0=6 /t (+
•\Dales, Cn /P"°h 6 v„ rIes -1474,,, 1( 44F__ el, r`jA#-