820091_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

type of visit: Lj'Uom trance inspection V vperanon xevtew V btructure tvatuatton V iecnmcal Assistance
Reason for Visit: (Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:i j ,�� Arrival Time: S Departure Time: ; f County, S4flfto Region: r
Farm Name: _ r �J �� `��'"1 Owner Email:
Owner Name: -Gl yn cs 6 r y1 �� n Phone:
Mailing Address:
Physical Address:
Facility Contact: .c.- JI s 3 ct [ Title:
Onsite Representative: I�
Certified Operator: _] +(� f 0 All 7J;
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 915—S
Certification Number: Z
Certification Number:
Longitude:
4
Design Current
[3 -NA
Design
C►orient
Design Current
Swine,.
Capacity . Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
.T
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
ZO Y[;J
�'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Poul
Ca aci
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
a,k
. � V ,..
Turkeys
-
Otlier�
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 LJ "'o ❑ NA [] NE
❑ Yes
❑ No
[3 -NA
❑ NE
❑ Yes
❑ No
Q-IgW
❑ NE
❑ Yes
❑ No
❑ Yes
[2 -No
❑ Yes
No
QUA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

Facili Number:2-- cfjFD—ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 -N`5 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No Q -NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J-7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes lB iqu ❑ 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 [D leo ❑ 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 a vironmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes`,Eg+k D NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q�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 -No ❑ 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 E]<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): �3� "it fyI-i- s 6 D f P,
13. Soil Type(s): o a I h G((
14. Do the receiving crops differ from those designated 14 the CA
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
to
❑ Yes
D o
[] Yes
Er
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [ -fro ❑ NA ❑ NE
0 Yes [ ]' o ❑ NA ❑ NE
❑ Yes E3'Vo ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2). Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [(�-N`8` [DNA ❑ 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 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 2/4/2011 Continued

Facility Number: Z - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0,Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i -e-, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes D-'<_ ❑ NA D NE
❑ Yes Ellor ❑ NA ❑ NE
❑ Yes CA'I5ro— ❑ NA ❑ NE
❑ Yes [2-lqo ❑ NA ❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes
E 1 o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to betterexplainsituations (use additional pages as necessary).
Ga (lb r_4 ro—. 0 - 3 (� b
�. C�
C-e.Q Flo- 30k-- 6 ?V
Reviewer/Inspector Name: d] t Phone: %Q^'1433 -33Y
c
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412 1 S

L +uS KU
rvis-ion of Wa
ter Resources
Facility Number C - ® Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ommpliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Grxoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: / , � L ' Arrival Time: Departure Time: County: LRegion:
Farm Name: '�-�� 3 a�yl,t
Owner Name: ,f
Mailing Address:
Physical Address:
Facility Contact: (�.0 r ecxlW� � Title:
Onsite Representative:
Certified Operator: OA ' �fK
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator: S
Certification Number: 1'7 q -Z L
Certification Number:
Latitude: Longitude:
Design Current
❑NE
Des gn�C rent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity` pop.
p.
Cattle Capacity Poammo
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
ai Calf
Feeder to Finish 7 a
— -- ""Dairy
Heifer
Farrow to Wean
Design ,..Current
Dry Cow
Farrow to Feeder
D Pau!
Ca " achy P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1, is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ❑�Pda - ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []"No
[:].Yes EfjNo
P -NA ❑ NE
[]-1qA ❑ NE
❑NA
❑NE
❑NA
F] NE
❑NA
❑NE
Page I of 3 2/4/2015 Continued

Facility Number: iL_- jDate of Inspection: Al uf
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
No ❑ NAS❑ ONE
❑ No DITA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S �`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes M N -o ❑ 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 El -No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F'1< ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F J 'Yo ❑ 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): 10 Z Jao -,_j q �:�b 10
_
13. Soil Type(s):_S L,
14. Do the receiving crops differ from those designatedln the CAWMP?
❑ Yes
[D"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q 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 EKO ❑ 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 E2-,Iqo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [jNo [] NA ❑ NE
Page 2 of 3 21412015 Continued

FacilitS, Number: jDate of Inspection: ZA
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [_lo 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 E2111To ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes Q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CDNo' ❑ 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 Q No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes PJ'No ❑ NA ❑ NE
permit? (i.e.. discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes E"1fo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/[nspector fail to discuss review/inspection with an on-site representative? ❑ Yes [TNo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date: W
214120 5

Type of Visit: Q�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q�doutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: r—ft-1)
Farm Name: P"t V41 Owner Emall:
Owner Name: 'T100ttr-5 0 1101"4A'X4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator;
Back-up Operator:
Phone:
Integrator: Ig T —Y
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
ine
an to Finish
Design ur ent
�Hpacj 0
E3I.NT- F] NA
DI -
--ifq A,
acii 0
esign _Cu r
ttle
Dairy Cow
an to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
nne
e
Ul
Layers
Non -Layers
Pullets
ui
T -keys
Turkey Poults.
esign, U env
papa i P
'op-
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy_
Beef Stocker
"B ef Feeder
I
1 'Bet -.f Brood Cn­4
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
er JR,
_,Other
E�J-NA
NE
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[:) Yes
E3I.NT- F] NA
F] NE
Discharge originated at: E] Structure E] Application Field F-1 Other:
a. Was the conveyance man-made?
E] Yes
[-]No
[2 -NA
E] NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Yes
No
E�J-NA
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
No
[�NA
NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
Cg4o
NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
ETNo
NA
NE
of the State other than from a discharge?
Page I of 3 21412011 Cominued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3--Nb ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []-#A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[BNo
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2"No
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
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.)
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3 No
❑ NA
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?
the appropriate box.
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[j�rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F:;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[�N�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�i o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F1 ble ❑ 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): A
13. Soil Type(s): N'J61 , Ly
14. Do the receiving crops differ from those designated in tide CAWMP?
❑ Yes
[2Io
❑ 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
[2"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
[3*f4o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:I 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 E3<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [ "No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�J'No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: jDate of inspection:
24. Did the- facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�J- (o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Io ❑ 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 [y No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [;3"No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [2�No ❑ NA ❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes E leo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes [fNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes E�f`No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [!rNo ❑ 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).
Q�;6
- -��t)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
4A
C
Phone: q3
Date: 16 Wk
21412011

Type of Visit: tDXom fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: QrRoutine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time:10� Departure Time: County:'_q__�
Farm Name: a te'4 Owner Email:
Owner Name: &w4_WA r+^ Phone:
Mailing Address:
Physical Address:
Facility Contact: �V + C i3 G+�`(,(J l� Title: Phone:
Region: C�
Onsite Representative: r Integrator:
Certified Operator: �� S— `{ l ` f %0
p � Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
- Design Currents
z
Capacity1?op.
Design Current :
Design Current
Swine .
Wet Poult .
ry
Ca acs
p ty Pop. �
►attle Capacity Pop.
C
-
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish._:.
n
Dairy Heifer
Farrow to Wean
Des iga Current
Ury Cow
Farrow to Feeder
Dry Poul
Ca aci z„Po =
�3
Non -Dai
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
"r
Beef Brood Cow
Turkeys
w y
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o [:DNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [D�ITA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes [-]No 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) D Yes ❑ No [3<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes IS No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E�rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility umber: Date of Inspection:
5
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
E]"No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[l [' o
❑ NA
0 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
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
2l. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3No
❑ NA
Observed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
[ "No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[344b
❑ NA
❑ NE
waste management or closure pian?
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
[allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2,110
❑ 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 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[D No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes aeo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence jof Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): G �� a S (3 -
13. Soil Type(s): k p u) A,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Lj.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes El"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes EJ�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E]"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E2,<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[TNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ "No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facili lumber: - Date of Inspection:,Tt 1Inspection:,4c.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [4 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D-1 ❑ 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 ClNe- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes 2-N—o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes[�1
iso
❑ 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
NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[3�o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
El -No-'_
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
[3-5—o
❑ NA ❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[g -#o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q'14o
❑ 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/lnspector Signature:
Page 3 of 3
er,
o-64 J6
42- o- ef,1
Phone: " 1 A% "%—
Date:
% -
Date: N "_ _.�5
2/4/2014

R (W /a- W., ILI a D
Type of Visit: (10ance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: (DRoutingr 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:` Region:
1 l'-
Farm Name: �� ,q,l �j r� � Owner Email:
Owner Name: &evil Phone:
Mailing Address:
Physical Address:
Facility Contact: Cx['41 S �Q G4 Title:
Onsite Representative:
Certified Operator: r
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
DesigMyQC&ACUM untDesrgn
Current'
Design Current
Swine
Wet
Pop.
Wean to Finish
Layer
F
Dairy Cow
Wean to Feeder
INon-Layer
I I
Dairy Calf
Feeder to Finish
''
Dairy Heifer
Dry Cow
Farrow to Wean Design vCu . ent
Farrow to FeederLIP"*
a ci =- Pia
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes M? o NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
EJ_N�A ❑ NE
LJ44A__1E] NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [—]Yes ❑No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E2'& o ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes qo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Ins ection:
r •
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 ETI A ❑ NE
Structure 4 Structure 5 Structure 6
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 ET -go NA ❑ NE
❑ Yes 2&"o ❑ 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 E1ro ❑ 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 f!j No ❑ NA O -NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes O 1 ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E o ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): grd-ot1 r7o�_ S6 0 e --W(5 L�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the
WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
❑ Yes
❑ Yes
�No ❑ NA
FTN -o ❑ NA
Dl<o ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes
Structure I Structure 2 Structure 3
Identifier:
❑ NE
Spillway?:
No
Designed Freeboard (in):
❑ NE
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
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 ET -go NA ❑ NE
❑ Yes 2&"o ❑ 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 E1ro ❑ 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 f!j No ❑ NA O -NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes O 1 ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E o ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): grd-ot1 r7o�_ S6 0 e --W(5 L�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the
WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
❑ Yes
❑ Yes
�No ❑ NA
FTN -o ❑ NA
Dl<o ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes
I_J -Z
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes U 'Yo
❑ Yes Ll' o
❑ NA ❑ NE
E] NA ❑NE
[:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E5�M'o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Zo ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number. -UV Date of Inspection;)
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes aN.
m ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2r<o 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 [ E No ❑ NA ❑ NE
❑ Yes! 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
E leo ❑ NA ❑ NE
C] NA ❑NE
VC ❑ NA ❑ NE
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 (ase additional pages as necessary).
r
` � r
Reviewerllnspector Name: P% J J
Reviewer/Inspector Signature: Date V
Page 3 of 3 2%

type of visit: Qffc:ompnance inspection V uperation mevtew v structure tvaivation V tecnnicat Assistance
Reason for Visit: 01toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: !3U County: — Region:14a
Farm Name: Owner Email:
Owner Name: Ili, �'jl�p{Z�jp� Phone:
Mailing Address:
Physical Address:
Facility Contact: C• M g gq'j&UC Q Title: Phone:
Onsite Representative: spcn
Certified Operator: p fn Eh fq
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: I -I ci—ak0
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
-
Design
Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design
.Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ No
[2rNA
Layer
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Wean to Feeder
d. Does the discharge bypass the waste management system? (Ifyes, notify DWQ)
Non -Layer
❑ No
dNA
Dairy Calf
Feeder to Finish
❑ Yes
[�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Heifer
Farrow to Wean
❑ NA
❑ NE
of the State other than from a discharge?
Design
Current
Dry Cow
Farrow to Feeder
D , Poultry
Ca aeity
1Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
11
Turkeys
g
Other
Turkey Poults
Other
I Other
I
E I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
[:INA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[ kNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[2rNA
EINE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifyes, notify DWQ)
❑ Yes
❑ No
dNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
1► No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: a - Cj Date of Ins ection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [jfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No j/NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ;d3 41
Spillway?:
Designed Freeboard (in): I of �Q
Observed Freeboard (in): 2)0—; j (Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o'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 E3"'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 Q�No ❑ NA r] 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ff No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): s,�) f 1'i M V p It:: -
13. Soil Type(s): i�amf') NckLfol1l- G' -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes EV No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ff No ❑ NA ❑ NE
[—]Yes dNo ❑ 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 [2rNo ❑ 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 CYNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [S�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 214/2011 Continued

s
Facility Number: - Cl t Date of Inspection: U /
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 D No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ❑No EY/NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 -c-, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes [:]No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: `a Ask 0—
Page 3 of 3 V 214/2011

ype or v 1511: Uv t-ompnance taspectton V "peranon xeview v MFUCEure r.va[uauou V i ecnnicai Assistance
Reason for Visit: GH outine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: �. Departure Time: County: Region: "1�]
Farm Name: Owner Email:
Owner Name: - Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ��,� Phone:
Onsite Representative: Integrator: -j
Certified Operator:Certification Number: /
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
De"signCurrent °Design Current' . Design Current
S .
wYne Capacity Prop Wet Poultry CapacitvPop C►attle Capaeity Pop.
r
Finish La er Dai Cow
Feeder Non -La er Dai Calf
o Finish 3 "" Dai Heifer
�o Wean f s DesignCurrent D Cow
oFeeder D Poul ,,Ca act Po '� , � � � ' + �. Non -Dai
o Finish La ers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
to
Turkeys
Turkey Poults
Other Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 Vo [DNA ❑ NE
❑ Yes ❑ No E51NA ❑ NE
[:]Yes D No g�J<A ❑ NE
❑ Yes
[] No
+2'isTA
❑ NE
[:]Yes
[g<
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

F acili Number: 7- Date of Inspection: d
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [R<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes z �/ ❑ NE
Struc re f1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_ a
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 10<0 ❑ 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 C3 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 10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes i 0 ❑ NA ❑ NE
maintenance or improvement?
_ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ 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.
ype(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
li No
❑ NA
❑ NE
[:]Yes
E3 No
❑ NA
❑ NE
❑ Yes
Eg<o
❑ NA
❑ NE
❑ Yes 03"N"o ❑ NA ❑ NE
❑ Yes [0'*No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[E<o o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
[DNA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? I f yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
E3<A
❑ NE
Page 2 of 3 214/2011 Continued

Facili ' Number: jDate of Inspection: 1A
/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E "1O ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ©,iVo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes fo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E]Yes ❑ No E-11AS❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E i<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E�r<o ❑ NA ❑ NE
❑ Yes [B<o ❑ NA ❑ NE
[:]Yes [ElNo ❑ NA ❑ NE
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
[+�Vo
❑ NA
❑ NE
[:]Yes
[j4o
❑ NA
❑ NE
Comments (refer to question ft 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).
4e-1 0LVd1kXj �
6
Reviewer/Inspector Name:
Reviewer/inspector
Page 3 of 3
Phone -1/U —7
Date:
2/412011

RT4fS Z -os -20/D
Type of Visit,,C��ommp�pliance
Inspection
0 Operation Review 0 Structure Evaluation
O Technical Assistance
Reason for Visit
t7xoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: %—Z g -/O Arrival Time: % /D Departure Time: /%$S County: Region: Flo
Farm Name: Owner Email:
Owner Name: J w^ts. ft: _A,r-AJ Al Phone:
Mailing Address:
Physical Address:
Facility Contact: ��+t'� S �QY W tZ [�
Title: ; f
sp t •
- Phone No:
Onsite Representative:
❑ Wean to Finish I I❑
Integrator:
tfiQ>kc v 1 C__
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =I = 11
Longitude: = o = 0 u
DesignCurrent
Swine Capacity Papulation
Design Current
Wet Pouttty Cap�a�ci�ty Population
Design Current
Cattle Capacity Population
❑ Wean to Finish I I❑
La erI
,.,/
L+�J No
Dairy Cow
❑ NE
❑ Wean to Feeder I I
Non -Layer I
Dairy Calf
Feeder to Finish 13720 1 D
❑ Dairy Heifer
❑ Farrow to Wean
Drs° Poultry
ElDry Cow
❑ Farrow to Feeder
P❑
Non -Dairy
❑ Farrow to Finish
❑ La era
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Yes
❑ Turkeys
13<A
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
o'
❑ NA
❑ NE
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
,.,/
L+�J No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
[IL7 No
,�/
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[J<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
1�,S 1- No
13<A
EINE
2. Is there evidence of a past discharge from any part of the operation?
Yes
ElL'
o'
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:]Yes
O<o
❑ NA
❑ NE
other than from a discharge?
12/18/04
Continued

Facility Number: Z — 91 Date of Inspection
❑ Yes
L��[3<oElNA
4Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
[-IYes[3
o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ffNo,
❑ 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:
18. Is there a lack of properly operating waste application equipment?
[71Yes
UK
Spillway?:
❑ NE
Designed Freeboard (in):
Observed Freeboard (in): ZZ Z g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 8No
❑ 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 L"1 No ❑ 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 E� 'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L"! No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q 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) 8<.*- 44 dk_ (Gro5c 2 Small G,'ai'iv (O. S. ) . /f -llcA � R4c- KAAIV4u ./s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L��[3<oElNA
[INE
15. Does the receiving crop and/or land application site need improvement?
[-IYes[3
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
El NA
El NE
17. Does the facility lack adequate acreage for land application'?
El Yes
,T1vo
L_
[:1ElEK
NA
NE
18. Is there a lack of properly operating waste application equipment?
[71Yes
UK
❑ NA
❑ NE
Reviewer/Inspector Name , � ' /Qc /e.(S x y� _ Phone: 910, V 33, 3360
Reviewer/inspector Signature: Date: /- a $ - 7- 0/0
12/28/04 Continued

{ Facility Number: L92— q/ Date of Inspection F/_ -2__f_3 -/O
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi El Other
Design El
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ 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
,/❑
I��J Ng�o
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
i_KO
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[B<oo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I—YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
G <o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[a<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
GO
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
G - <o
G
❑ 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?
El Yes
�,/
I <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
,��
[1 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
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[Ko
❑ NA
❑ NE
Comments and/or Drawings:
12128104

1,144S ro-a s- z O O 9
Gutvision of Water Quality
Facility Number Z q 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit (9,6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: —/ -09 Arrival Time. Departure Time:Z: �� County: S4649S#al Region: Afa
Farm Name: tri`^ Owner Email:
Owner Name: J CL"e-a 14. 11ftb,v-m lQa r ! Phone:
Mailing Address:
Physical Address:
Facility Contact: �; art�r c-� Title: SPe C ' Phone No:
Onsite Representative: Integrator:�o
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
_Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =,
Longitude: = ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design
Cattle Capach
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coixj
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 ffoNo ❑ NA ❑ NE
❑ Yes
❑ No
3<A
❑ NE
❑ Yes
❑ No
�A
❑ NE
2'5A
❑ NE
❑ Yes
❑ No
❑ Yes
Ej-lqo—
❑ NA
❑ NE
❑ Yes
GKo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 82— g j
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure Structure Structure 3 Structure 4
Identifier:
❑ Yes Ifo ❑ NA EINE
❑ Yes DNo [] NA EINE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C{/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EI'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? El Yes [� N [:1 NA [I 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 ETNo ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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 1
12. Crop type(s) _ _�xrw.k dw [ 6a,-e"e_� Al6,M"a e-0. M.Y%_j eyC_ e;V W-.1SJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application'?
❑ Yes
B o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3'�Vo
❑ NA
❑ NE
= queshan #) �Explatn any�YES�ans vers and/ r spy r,ecommendatinnsor any other comments.
g �#y% 1 etteeciplaIn,situah©n (usexaddrttanal pages as aec�
Use drawin sof fac�ll #orb _t
Reviewer/Inspector Name �; Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: . — f I Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 B o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErNo
[-INA
❑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
C I No
❑ NA
EINE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
BN
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ Yes
E:1 NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El!� Yes
,BNo
tvo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes !_J No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3 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
,.,N�
Lf o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,,.�,,//
BNo
❑ 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
ffNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28104

(isms
I OR on of AWE
FaciItty Number $� ` q Division of Soil and Water Conservation
Other Agency
type of VisitCommpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 outine 0 complaint
0 Follow up Q Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time- wr Departure Time: County: �A-158AI Region:
Farm Name: J Ga k -A-1 Owner Email:
Owner Name: ., at 1 H • f ha Y-,v4o M Phone:
Mailing Address:
Physical Address:
Facility Contact: -Cur-As Ra t wlt G !< Title: ZZ-4.SQC G • - Phone No:
Onsite Representative: intepratar: CQ j -u 1r-1 C_ rw► s
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I 0 i! Longitude: =0=6
°=6 =
Ild
Design Current
Swine Capacity PopulationPopltry
❑ Wean to Finish
Design Current
Capaci Population
❑ La er
Design Current
Cattle Capac Population
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dairy Calf
❑ Feeder to Finish 311 9
�/
L7 No
❑Dairy Heifer
❑ Farrow to WeanD
'-ry ultry
Po
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Fe eder
❑ Boars
El Pullets
❑Beef Brood Co
Y
❑ Turke s
Other _
❑ Other
❑ Turkey Poults
❑ Other
Numiier of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
Discharees & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Yes
El,
�/
L7 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
El No
��
L7 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
,_,NA �
L7
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ET'iVo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
3No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

13. Soil type(s) A1, t4c4 k idi 7, sym - - zymc k borC, 0
Facility Number: Date of Inspection %3 -
14. Do the receiving crops differ from those designated in the CAWMP?
Waste Collection & Treatment
No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
NNo/o [__1 NA
El NE
a. If yes, is waste level into the structural freeboard? El Yes
,,
o ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
El NE
17. Does the facility lack adequate acreage for land application?
Spillway?:
,E
L1 No
❑ NA
Designed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
❑ Yes
22LL
Observed Freeboard (in):
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
2No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
,
LI"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? [:1[ Yes
tvo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
to ❑ 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
�,��
L�No ❑ NA
El NE
maintenance or improvement?
Waste AUolication
10. Are there any required buffers, setbacks, or compliance alternatives that need [IE Yes
��
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElE
Yes
1110 ❑ NA
E11105`11
❑ 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
(SYN C»Ah
12_ Crop type(s) &erq"'4 do, `�""D . s-'.AS*"w (0• S• J som."C - f W r'j �NNwct/S .
13. Soil type(s) A1, t4c4 k idi 7, sym - - zymc k borC, 0
14. Do the receiving crops differ from those designated in the CAWMP?
El3 Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ yes
D o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
NN o
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,E
L1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Dl�o
❑ NA
❑ NE
Reviewer/InspectorName �,� _ ���l�f:. S Phone: 410 5',33.,3330
ReviewerlInspector Signature: Date: i'J ` / - ZOO
Page 2 of 3 12/2$/04 Continued

Facility Number: $Z Date of Inspection -
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ tvo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g ❑Maps El Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Blo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
[IL
�QNo
NA
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,�,iNo
L7 N/o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U<o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,,...//
B o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
OrNo
❑ NA
EINE
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`?
El Yes
,_ �
B o
❑ 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
ETNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B o [INA
❑ NE
Page 3 of 3 12/28/04

1
® Division of Water Quality
Facility Number gz O Division of Soil and Water Conservation
0 Other 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. Arrival Time: Departure Time: /D'.30 Aw. County: S�pSdN
6fpT, -
Farm Name: z � J Fal- vA _ Owner Email:
Owner Name: Q0LmC5 Phone:
Mailing Address:
Region: FR.0
Physical Address:
Facility Contact: C ux--6 5 'PSCvt.3► c.k Title: '• j-• Phone No:
Onsite Representative: C kAv-+ Integrator: Coriatri ` iiwlS
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
❑ { ❑ Longitude: =o=, ❑ "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 392 O X03
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Capacity Population
❑
Daia Cow
❑ Daia Calf
❑ Daia Heifej
❑ Da Cow
❑ Non -Dai I
❑ Beef Stocket !I
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E'
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 ;n No ❑ NA ❑ NE
❑ Yes
m No
❑ NA
❑ NE
❑ Yes
R No
[INA
❑ NE
❑ NA
❑ NE
❑ Yes
[;D No
❑ Yes
V No
[:INA
❑ NE
[]Yes
[�?No
❑ NA
EINE
11/18104 Continued

f •
Facility Number: 2 —
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 l Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes Q§ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [XNo ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes R No [INA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [1] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ff 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 [N No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%, or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Cori n1 f Coo-jmN. F,c �i�.�u « _Cc&7m4,I t;:�._ r ` 1 S. G, iouwS�pd) A WA
IF
13. Soil type(s) �cr ajYc yt L vacA16 !4
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 [)B No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes V] No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Rj,- K Re ve-1.s Phone: 2/0,f'33,23300
Reviewer/Inspector Signature: RA R tom_ Date: !O -O$—_200 7
12/28/04 Continued

f• 4
1
Facility Number: SZ — Date of Inspection 70--08 07
Required Records & Documents
19. Did the facility fait to have Certificate of Coverage & Permit readily available? ❑ Yes 7 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [21 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes wNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
;] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PM 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 fait 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
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?
❑ YesNo
Fj
[INA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes®
No
[INA
[INE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
9 N
❑ NA
❑ NE
12/28/04

Type of Visit *Compliance Inspection O Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: -5df!:AS6N Region: x.70
Farm Name: _ L S �,,.� S _ _„ Owner Email:
Owner Name: J r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,Phone No:
Onsite Representative: 6& integrator: ecy4q Y,i Cf_
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o 1——] A =" Longitude: E__10=1 ="
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design
:Current
WCaignCurrent
Design Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Swine
Capacity"t
P pulsation Wet PoulcItytiPopulat'on
a. Was the conveyance man-made?
Cattle @apacity Population
�..
MNo
❑ an to Finish ❑ La er
❑ NE
❑ Da Cow
❑ Yes
❑ an to Feeder
❑Non -La er
❑ NE
❑ Da Calf
® Feeder to Finish 1
3700
Z
`.
❑ Dairy Heifer
❑ Yes
[4 No
❑ Farrow to Wean a
t�i)ry Poteltry �:,����,��i'=a
El D Cow
El Farrow to Feeder
❑ Yes
P9 No
❑ NA
❑ Non -Dairy
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Farrow to Finish
NPNo
❑ Layers
El NE
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Page I of 3
❑ Beef Feeder
Continued
❑ Boars
-
❑ Pullets
u ❑ Turkeys
❑ Beef Brood Co
ax�
Other ❑ Turkey Poults
❑ Other
.> .
r,c; F, Nit µ.,
❑Other
a
Number of Structures:Ej
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
r"No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
MNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑ Yes
[0 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (It -yes, notify DWQ)
❑ Yes
[4 No
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P9 No
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
NPNo
❑ NA
El NE
other than from a discharge?
Page I of 3
12/28/04
Continued

1
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
.Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ClNo ❑ NA' ❑ NE
❑ Yes (A No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
rr ^'
Designed Freeboard (in): 9
r.
Observed Freeboard (in): 33$7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9 No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [ VNo ❑ 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 INo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
W No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Name ��7/G A S
ReviewerlInspector Signature:
Phone: 9/f9)
Date:
❑ 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
r
12. Crop type(s) �Ay* c✓ w M /�r tiNk GlS . 8en�k e - ��' �; SXr�iI�G.�•!✓
�D%5�.
C�OA U. Ca VAf
13. Soil type(s) __ A104 Ufa c L, -o-- / ,_,v/Z 4 J �I
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
QfNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[PNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
VZNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
X,NO
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
IIse drawings of facility to better explain situations. (use additional pages as necessary,):
Reviewer/Inspector Name ��7/G A S
ReviewerlInspector Signature:
Phone: 9/f9)
Date:
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LkNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UTNo ❑ NA ❑ NE
the appropirate box.'
ElWUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
A No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
AI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,K No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
26 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
& No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P9 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
9 No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
IN No
❑ NA
❑ NE
12/28/04

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. Arrival Time: Departure Time: County: 4L,3 rn Region: `eO
Farm Name:. 046i IT F /'In __ Owner Email:
Owner Name•f/I Phone: 'f/0-533-3`fy 9
Mailing Address: _ /7/0 104,he...A-e IPnCirlt 62 :sen f _IVC
Physical Address:
Facility Contact: c,d;s &xt 9,..'e iC Title:
Onsite Representative: Qac
Certified Operator: Jermnrs -_ If
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: CD ka-�,'e
Operator Certification Number: /2 x.70
Back-up Certification Number:
Latitude: = o ='
ET
Longitude: = ° = { = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer �## ❑ Dairy Cow E:
I.Q. Non_La er - J ❑ Dairy Calf
❑ Wean to Finish `
❑ Wean to Feeder
I
PTeeder to Finish e
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts }i
❑ Boars -- I
Other
Design Current V
Cattle Capacity Population
Dry Poultry
❑ La ers
on -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow,
Number of Structures: u!
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 917fo ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[-I No
[I NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
❑ NE
El Yes
,�o
CJ No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: g, — Date of Inspection (� 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 1 Structure 2 Structure 3 Structure 4
Identifier: ZJ::= =: ::2 -
Spillway?: /2 Q I'! a
Designed Freeboard (in): —1q t� / 4 !"
Observed Freeboard (in): 3 9 // 31
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 9 o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [3'�o ❑ 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 [moo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [2rNo ❑ 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 2No ❑ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ['No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
X08 1,?3 J�3 73 rOo / p7�o 7`3�— Sv IV- rya
12. Crop type(s)U�.w. A.ewL..�s _,. �✓ y>(ii �nI`f /«n��� S,h��� G.o1 Cn.� C�r�itcn --
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C No ❑ NA ❑ NE
.te
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E31go ❑ NA RINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes ❑ No ❑ NA L E
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA [-113
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2 o ❑ NA ❑ NE
Comments (refer to question #): Explain_ any YES answers and/or any'. recommendations or any other comments.
Use drawings of faciiity to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name n� .CJr .arst. Phone: "!!�-�{gy ltirl eYf73o
Reviewer/Inspector Signature: Date: 3'18- OS -
12128/04 Continued

Facility Number: — Date of Inspection 3 o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box. ❑ 1x ❑ Cfists ❑ D gn ❑ hkrps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 2Yes ❑ No ❑ NA ❑ NE
❑Rtnfaifi ❑ sxee 7,opYield�C]1201vlitxuteltspeetion❑ M ❑ Weatlwt de
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
91res
❑ No
❑ NA
❑ NE
❑ Yes
C;Wo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[TNo
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA 2*1�E
❑ Yes BNo ❑ NA ❑ NE
❑ Yes
DNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
21�o
❑ NA
❑ NE
❑ Yes
Q'No
❑ NA
❑ NE
❑ Yes L;KNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
J
24 OleaSG lee -00
4 6-0/0
V
K -e /e/ fUfr+. >rF /0-1-j0499
i s 04 -0e &4ly Ory y e6 se,(
f''�lcfs j ✓s
rr9st
f :'s/ci a( �.�e/ �.... "><�
f', `e/a/
Ye LF C)"'y
�a)
,S c..t �r�s� �-rr iC
O'•Own %idri .►,G.r�. �.�/�S
.00 wele
Pte_ Pled:e Itff
u ru,:,
�� a as1
G�OSC TP 41G
IFiq pvy 4S �O,Fs.�/C
✓
IPa:� 9a !s
Gv�iv Rf:0),
a7� �jnvsC,
12/28/04

Facility Number Date of Visit: Tune: �v
Q Not Operational Q Below Threshold
Qrmitted 9M<e"rtified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: -- .................... - ._._ - .. County: ... -h .....� .� ...� ........_.
Owner Name: °r"s`�� Phone No:
Mailing Address: _.17/a._.„.Pa",11lt l�diiSoh
.. .....-• --e
Facility Contact: +
..� ... ...—►� �'itle:.........._...-•------_........................._.. Phone No:
Onsite Representative:
...........'L^.��.........��'.�!:l.lr�............................................ Integrator•. .......�,Q�'A�f:l�....�... .................
Certified Operator :...... !�"��.....:. �!'!Qn+`�ri..W .._.. W ..... Operator Certification
Location of Farm:
Ejl�wlne ❑ poultry ❑ Cattle ❑ Horse Latitude " ' ” Longitude • ` 94
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes zw6
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... ..................................................... .... ... .............
Freeboard (inches): 31" 3f r
❑ Yeso
❑ Yes
❑ Yes Leo
Structure 5
12112103 Continued
❑ Yes
No
❑ Yes
❑ Yes
R O
❑ Yes Leo
Structure 5
12112103 Continued

Facility Number: g2 — Date of inspection 1 51' 0+
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?
I 1. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes gpw�-
❑ Yes
❑ Yes P+ro
❑ Yes Eaxi "
❑ Yes 2+mQ
❑ Yes pLk�
❑ Yes Miro,
12. Crop type r • %#' r., W `RMj Liu—1(401�n1,-.
13. Do the receiving crops differ with those designated in the CertifidAnimaf Waste M agement Plan (A )? ❑ Yes 0jbie--
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Qlqo�_
b) Does the facility need a wettable acre determination? ❑ Yes 81<6 -
c) This facility is pended for a wettable acre determination? ❑ Yes 0-O
15. Does the receiving crop need improvement? ❑ Yes [3.Wo
16. Is there a lack of adequate waste application equipment? ❑ Yes UWT__�_
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ETKo'
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes B.Pd'(i
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 8"190
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
wCamments (refer to �nestton #) Eaplaua auy YES answers and/or any recommeadatfons oc any�other comments. �� -
;Use draw�'af fact'hty to better explain sttuat� (use 8ddt�ona! pages as .sary)�,� teld Copy ❑ Final Nates �� �:
Sid 4Ad wtyJc 1 �5 c�K
Reviewer/Inspector Name.
ReviewerAnspector Signature: Date: t7 O
12111/03 /l Continued

Facility Number: IT— Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
Q 2 Minute Inspections ❑ Annual Certification Form
❑ Yes Leo
❑ Yes LSO
❑ Yes
❑ Yes B1f6E
❑ Yes elTo�`
❑ Yes ff o
❑ Yes ��O
El Yes Leo
El Yes L. o
es ❑ No
❑ Yes
[}I 'o
❑ Yes
a o
❑ No
CrVes­
❑ No
❑ Yes
two
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
5 6�-f�JJ &x t weir. Al f
7
12112103

Site Requires Immediate Attention: WA -
Facility No. 8;. - ct t
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: lc) '• ►5
Farm Name/Owner: Frkg M
Mailing Address: R -r Z T3 o_c 1q-1 - A F a t s stj W G I-8 la, Lt I _
County: 5aa.�sa,u
Integrator:_' _ Gshe.r.�. .!, , Phone: to
On Site Representative: 'TvNevire., Phone: s;; - 3 IiLt It
Physical Address/Location: ?5,'l Fin s a('6 N K,
Type of Operation:
Design Capacity: _
DEM Certification
Swine k
3q6 -1-a
Number:
Latitude: '
Poultry Cattle
Number of Animals on Site: 3 r% z a,
ACE DEM Certification Number: ACNEW
Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)es r No A ua] Freeboard: _Z- Ft. G Inches
Was any seepage observed from the l9�r
(s)?r o as any erosion observed? Yes or&
Is adequate land available for spray? No Is the ver crop adequate? Yes or No
Crop(s) being utilized: cp :,st., ►- c 0 -P—N Cpo Ac.WEs
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' 9 es or No
100 Feet from Wells? Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No �x�srtw� GovwJ
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or �Jo
Is animal waste discharged into water of Ite state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate was a management reco ds (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?Ye or No
Additional Comments:
ro %i _lc>GS - F1N,cxt0tCr
Inspector Name Signature - �- -
cc: Facility Assessment Unit Use Attachments if Needed.

REGISTRATION FORM FOR ANIMAL FEEDLOT OPE?ATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds t_` -at are served by
a liquid waste system, t`:en this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2-.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name:-- 94 r lrar.r, _
Mailing Address:
t - wl e' .a 7 7 7 --�;) Q z [.r l
County: Samos. -, Phone No
Owner (s) Name: 'T '-,..,.
Manager (s) Name:
T`� r.
Lessee Name:
Farm Location (Be as specific as possible: roan names, direction,
milepost, etc.): 7. .1 =; Ks 4FFaf- e1C 11D3
Latitude/Longitude if known:
Design capacity of animal waste management system (Number and type
cT confined an_.mai(s)Q:,1 sy",e
Average animal population on the farm (Number and type of animal(s)
-raised)q�D-,,,.�/Year Production Began: k? ASCS Tract No.: F ` GSd
Type of Waste Management System Used:- X.k�G
Acres Available for L nd App is i f aste : 4 /;�
Owner (s) Signature (s DATE :l b
�} DATE:
W3 a C �•:, fi _ 4rProX �, S ..�, ��s . T4�.. /rfF
O h Kew, Pa 11 A Rn J/e

II' .