820099_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Date of Visit: { 19 Arrival Time: ! i . Departure Time: p"4 pr? County: SFr 0 s u Region: 1 'fes
r 1
Farm Name: e 6VL 4-I� p+ �� 55 Fc f -M Owner Email:
Owner Name: 0 t f e oN Z o-, 5 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: C u av^ ��� 'Title: Phone:
Onsite Representative: '^ 1 s Q �l` W t { Integrator: t� i rcf q �-
Certified Operator: Certification Number:
Back-up Operator: t/l). , 1J etS Certification Number: Ct j D q Z-%
Location of Farm:
Latitude:
Longitude:
..
❑ No
[Z[,�4A
❑ NE
❑ Yes
W} Design Current
[D -NA
Design
Current
Design Current
SwineCapacity Pop.
Wet Ponttry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish 3 1 Zqq 38
—
Da Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . iPaul
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other f _
Turkey Poults
Other
t7f0ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[]Yes [t Nb ❑ NA ❑ NE
❑ Yes
❑ No
[Z[,�4A
❑ NE
❑ Yes
❑ No
[D -NA
❑ NE
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes [3 -No
❑ Yes D—No
�NA
❑ NE
[] NA
❑ NE
E] NA
❑NE
Page 1 of 3 214/2015 Continued

Facili Number: - Date of Inspection: 9Srfl
Ig
Waste Collection & Treatment
4.
Isstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): JCC
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
[5No
❑ 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
[2'1`lo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C],I<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E3No
❑ 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 C3 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): CW is iZ'e,f r s Q
13. Soil Type(s): �10
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 [ENo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑-1qo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [] No ❑ NA [] NE
❑ Yes Cf�_No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes fNo [DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [:]Yes ['rNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [,Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " RainfaIl Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes fflNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El"No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - IDate of Ins ection: S &0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [t,'No ❑ NA ❑ NE
25. fs the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'1�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [D—No [DNA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [3'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
[3 -No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2,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
[3'1�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
[�io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3—No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[�]rNo
0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EErNo
❑ 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).
Cc.,� 11 r�__A 10 L�%. — (�; _ �-[ —I � - 17
Sl G.-��-e S L. -q -v — 3._ _ lz-�{ S 3 (Zc ��wv•�i j�a.�- ��
_rA -Ito - 3 0116-.( 6s
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ky' q .� 3 . 3 q
Date: SA. I 18
214A 15

" ivis'ion of Water�Resources 4„ _ -�'` � _
Facility Number 19 1 �ivision of Soil andWater Conservahori �w�� 4
gy Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Ag,Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: p Departure Time: County:
Farm Name: � G SS 13rr-%( Owner Email:
Owner Name: �(� o� r �4' _ SS Phone:
Mailing Address:
Physical Address:
Facility Contact: / a, -r' ` Title:
Onsite Representative:
Certified Operator: ,id" - &' -.r-,57
Back-up Operator:
Location of Farm:
Latitude:
Phone:
w Region
Integrator: & etj".P
Certification Number: a
Certification Number:
Longitude:
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?
❑ Yes fo ❑ NA ❑ NE
L] Yes ❑No Eff'NA ❑NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
[ffNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
E�J'NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[TNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
(—]Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Fjj No
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ Na
Identifier:
❑ NA ❑ NE
gam[# ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 CQ -#o ❑ NA 0 NE
❑ Yes UR -No ❑ NA [] NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes La.No ❑ 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 �a ❑ NA ❑ NE
maintenance or improvement'?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [«dts ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 8-156 ❑ 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): cu..) (5 5 C c
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[jKo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[!No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P'No
❑ NA
❑ NE
acres determination?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[!�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F],lgo
❑ 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
C!J"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement'? Ifyes, check the appropriate box below.
[] Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 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?
❑ YesNo
9
❑ 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 2/4/2015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E jNa- ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
2 -Mo- ❑ 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
0'1qo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P No ❑ NA
❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ,Z No ❑ NA ❑ NE
[:]Yes VNo ❑ NA ❑ NE
J
[:]Yes C�fNo [DNA ❑ NE
❑ Yes JZNo ❑ NA ❑ NE
❑ Yes [2rNo
❑ Yes ZNo
❑ Yes Z] No
❑NA E] NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to questaou #jEzplain-any.YES answers and/or;any addthonal. recomnzepdattOns Or anyo#hercomments_ -
Use'drawings.of facility to;h er�;eacpiain situations (use additional. pages'asneiessary)._#`
C"V IV4 ,
IL
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
ed— °tco-309-%8sr
Phone ,qj
Date: 1n1 f L
242015 S

Type of Visit: O Co -7
Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
t a o
Daf *isit' Arrival Time:t/� 1lJJj Departure Time: Bo County:
Farm Name: f),- (..... w- av 134 cr Owner Email:
Owner Name: !I Phone:
Mailing Address:
Physical Address:
Region,r
zD
Facility Contact: .. C4. r Title: Phone:
Onsite Representative: It Integrator:
Certified Operator:,Q���t.L� l7LI Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes []�o - ❑ NA ❑ NE
❑ Yes [:]No �A ❑ NE
[-]Yes ❑No NA NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No QNA U NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes <o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued
Design Current
Design
Current
Design Current
Swine
@specify Pop.
Wet Poultry
City Cod
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
D ' Cow
Wean to Feeder
Non -Layer
D ' Calf
Feeder to Finish
cr
airy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oultr
Ca.. _aci
P.o
Nan -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Of Boars
Pullets
Beef Brood Cow
Turkeys
rno;l
Turke Poults
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes []�o - ❑ NA ❑ NE
❑ Yes [:]No �A ❑ NE
[-]Yes ❑No NA NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No QNA U NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes <o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

F of
Factli Number: - (y p Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ Np E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? [-]Yes [] No E55A ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-7—
Structure
2-
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 [Z>o ❑ NA ❑ NE
❑ Yes [ k o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P<O ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [✓]'1Qo ❑ 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 E3�<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [.'No ❑ NA ❑ NE
maintenance or improvement?
1 l . 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 r E] Evidence of Wind Drift E) Application Outside of Approved Area
12. Crop Type(s): Cly <
13. Soil Type(s): �p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I 2No ❑ NA ❑ NE
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.
❑WUP ❑Checklists [—]Design [:]Maps ❑Lease Agreements
❑ Yes Ql�o ❑ NA ❑ NE
❑ Yes 2"No
❑ Yes dNo
❑ Yes �No
❑ Yes [21/No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [/o
❑ 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 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA 0 NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

Facility Number: L20L - 7 1 1 Date of inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 13<0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a FOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [� o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2No ❑ 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)
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 ul<o
[-]Yes [3No
❑ Yes [/No
❑ Yes [�N0
[-]Yes [ rNo
[-]Yes [!fNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or•any other comments. .
Use drawings of. facility to better explain situations;(use additional pages as -necessary).
6-
Reviewer/I
nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: U3 -333t
Date: 1b
21412014

131 M s
1crVWQ_ f S
I Type of Visit: ?,-Compliance
VCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (Dutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival, �Time: p Departure Time: County: %51VK! Region-75EZ
Farm Name: Owner Email:
Owner Name: �l Phone:
Mailing Address:
Physical Address:
Facility Contact: C"3 G cLAn .)4W1. Title: Phone:
Onsite Representative: a f Integrator: l
Certified Operator: Set -5,5 Certification Number: �$'f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Finish
Layer
Dai Cow
Feeder
Non -Layer
[
❑ NE
Dai Calf
Finish p
_Tt
E>A
❑ NE
Dai Heifer
Wean
W,Boars
Design
Current
Cow
Feeder
D 1'oultt.
Ca aci
P,o
Non -Dairy
Finish
Layers
E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Beef Stocker
❑ NA
Non -Layers
Beef Feeder
Pullets
Turkeys
Beef Brood Cow
Outer
Turke PouIts
Other Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
[] No
[
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E>A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ YesFNo
GA
E] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E]NA
E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
E] Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

lFachity Number: AOL=- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
P�Ko` ❑ NA ❑ NE
❑No fffNA 0 N
Structure 6
❑ Yes D -Ne ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes D-3Qo ' ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ETlgo ❑ 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 LJ 1 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Ef No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LJ leo ❑ 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): I� C.Avt,t,ty�.�
13. Soil Type(s): (�
- y _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [:Jo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E].W ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
Required Records & Documents
❑ Yes 0 o ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [jX4- [:INA ❑ NE
20. Does the facility fail to have all components of the CAW IP readily available? If yes, check [:]Yes [2r<o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [j ] -Ko ❑ 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? 0 Yes QA<o' ❑ 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 2/4/2014 Continued

[Facility Number: If,4
Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M.N'o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [21'1% ❑ NA ❑ NE
the appropriate box(es) below.
0 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Cj�bio ❑ 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 [�Lla ❑ NA ❑ NE
❑ Yes [2-lqo— ❑ NA ❑ NE
❑ Yes [2'1Go ❑ NA ❑ NE
❑ Yes C.3ND ❑ NA ❑ NE
[—]Yes
/ No
❑ NA
❑ NE
❑ Yes
[�No
[DNA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
Comments (refer to question.#): Explain any YES answers and/or any additional recommendations or any, otherrcommeuts ,
UseArav Ings of facility.to'better explain situations (use additional pages•as necessary).
C.Ix � r,,,+ ?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: J><ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 01Aoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Timer County: s % Regionf2�)
Farm Name: 2e470-1-1 Bar Owner Email:
Owner Name: L, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 4&eL-.
1(
Certified Operator: Pais
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes [R'No ❑ NA ❑ NE
[:]Yes ❑No E]-tl'K- ❑ NE
❑ Yes ❑ No [3.N� ❑ 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 ❑-N< ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Eq-ITo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑,?co ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number:- Date of inspection:
WV
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 E;k1dA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[( Woo ❑ 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
[:I,Fd'o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E4,No— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
E] NA
E] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
V___
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Zj_biw ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[Foy ❑ 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): 9a _-if
Soil Type(s): 1XZ'-t94
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Eg.N1r— ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3' °� ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E'K. ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 -No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[]J-Iqo— ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D -11`o`_ ❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists E] 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 V 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
E�No ❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

[Facility dumber: jDate of Inspection:
24 "Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Qylir❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] Nb ❑ 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 fust survey indicating non -compliance -
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [G.i,Na- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I_ y1To ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes []�q�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 V>;.- - ❑ NA E] 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 [34r5__[:] 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❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes [;j- o� ❑ NA ❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative? ❑ Yes L] -Ko— ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�1 - ❑ NA ❑ NE
{ quet' ) Pany
Yse any
coinmendahons orany other comments
Uwnofacilityobetter ex lain sivahons uadditeooalFa es as additional
� .
Ca
�f
[i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:7
l/4 011

Type of Visit ommp�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t /3 Arrival Time: Departure Time: County�d+�
3'.3a
Farm Na me_L ��t, �cr-5S �- ,� .ajpunefn- Owner Email:
Owner Name: 1� ,5,S� 5 � a1 -r -4s Phone:
G -
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator:
T"
Certification Number:
Certification Number:
Longitude:
nt
Design CuIle
Design
Current
Design Current
Swine
Ca aci
Poult Ca aci
Po P•
Cattle Ca aci Po
P h' P•
yrY a_..��
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
��- -- Design
Current
Dry Cow
Farrow to Feeder
D . P,oul rt ,Ca aci
Po
Non -Dairy
Farrow to Finish
I I Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I 1Beef Brood Cow
• .
,:;,,
Turkeys
Other
FurkeX Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes �o ❑ NA ❑ NE
[-]Yes ❑No
[—]Yes ❑No
❑ Yes ❑ No
❑ Yes allo
❑ Yes j. No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _C�_
Observed Freeboard (in): it(
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P -No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® 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
C3 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
3 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
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2�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): i'r�i�11/ 419cl
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CSNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
[:]Yes EjNo ❑ 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 Z. No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[:INA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: _� —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:)Yes 0 No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes F�SNo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ® No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ® No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes allo
❑NA ❑ME
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA C–] NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ##): Explain.any YES.answers and/or any additional recoinme`ndations:or any;other comments:
Use drawings o f facility to better explain situations (use additional pages as necessary):' _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: (!) Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grfioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y i7 Arrival Time: 01!t7t1 Departure Time:101 jW County: �qT
Farm Name:�'� 't L msVM�� Owner Email:
Owner Name: _ Kog sVy2j El A 4,.4�0 i%Ch Phone:
Mailing Address:
Physical Address:
Region: rRO
Facility Contact:y Ross qQ �.1� �}� Title: Phone:
Onsite Representative: 6p. MCL- Integrator:
Certified Operator: n RCS Certification Number: CtQ itga
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design "Current
Capacity Pop:
Wet Poultry
La er
Design
C►apacity
CurrentDesign
Pop.
Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
E!fNo
❑ NA
Non -La er
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Dairy Calf
Feeder to Finish
a.C�
❑ Yes
[:]No
ff NA
Dairy Heifer
Farrow to Wean
❑ Yes
❑ No
Design
Current
Dry Cow
Farrow to Feeder
D , P,oultry
Ca aeitV
Po _.
Non -Dai
Farrow to Finish
eNA
Layers
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Beef Stocker
Gilts
❑ NE
Non -Layers
❑ Yes
GyNo
Beef Feeder
Boars
of the State other than from a discharge'?
Pullets
Beef Brood Cow
w;
Turkeys
Otlil I: I. -Ill
IrCJOther
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:)Yes
E!fNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
ff NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[VYNA
❑ 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❑
o
eNA
❑ 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
GyNo
❑ NA
❑ NE
of the State other than from a discharge'?
Page I of 3 2/4/2011 Continued

Facili Number: - C17 jDate of Inspection: q ILI I ja
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No ❑ NA ❑ NE
a. If yes, is waste Ievel into the structural freeboard? ❑ Yes ®'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4,-4 ¢�
Spillway?:
Designed Freeboard (in): 1 C 9
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ff 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 E2rNo ❑ 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 CgNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Q'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
Required Records & Documents
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [j!fNo
❑ NA
❑ NE
maintenance or improvement?
E!(No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [7�No
❑ NA
❑ NE
maintenance or improvement?
the appropriate box.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ZNo
❑ 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): U0 Q
13. Soil Type(s): NRA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E2"'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [�2No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [9"'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
52rNo
❑ 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
E!(No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[ VdNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E f 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 [j�No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ff NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: SM -S5 Date of Inspection: i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ff No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes N�rNo
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 E�No
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 &fNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�fNo
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes Ea�40
34. Does the facility require a follow-up visit by the same agency? ❑ Yes gN 0
❑NA []NE
❑ NA ❑ NE
❑ NA ❑ NE
�NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: <U& Date:
Page 3 of 3 2/4/2011

Type of Visit: UComojance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region: f7jC
Farm Name:ya, O u tc. Vi wj t5jn Z- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: An.j WPl _ Certification Number: 1 r (Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream Impacts
Design Currenr
f',
Design
Current
Design Current
Swine
Capacity Pop. Wet }-x=
§
Capacity
Pop.
Cattle Capacity Pop.
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
�I I..Poultry
_
Wean to Finish
La er
❑ NoNA
Dairy Cow
Wean to Feeder
Non -La er
I
�D4
Dairy Calf
Feeder to Finish
O 3 7Q a
Dairy Heifer
Farrow to Wean
Farrow to Feeder
�x '.:
D Poul
Design
Ca
Current
P,o
Dry Cow
Non
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
aci
❑ NA
-Dairy
Farrow to Finish
Layers
[ 3 No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
113cef
Boars
Pullets
Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
Io
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NoNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�D4
❑ 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
A
❑ 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
[ 3 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0E'1Go ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I StructVe 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): -33
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 K. ❑ NA ❑ NE
❑ Yes OR< ❑ 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 Ea<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [,eo ❑ 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 To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 -No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 1. �l 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 ED Application Outtside_ off Approved Area
12. Crop Type(s): I{ M / Si G--, (�Or V 1) _ 513 L1 ",t f-
13. Soil Type(s): IyPoA
14. Do the receiving craps differ from those designated in the CAWMP? ❑Yesio ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E2<0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�f<o
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[T 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 ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes ErN* o
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [EKo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [9110 ❑ 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 to ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;I%[}#K'❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes 2-110 ❑ 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
10
❑ 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
0 -Mb"
❑ 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
2io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�
❑ NA
E:] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations -or any othericoiuiineufst ."
Ui9drawinis of facili#y tlAetter" explain situations (use additional pages as°necessarv).
Reviewer/Inspector Name: •_'Unirk,( �A-142 ,1 e Phone: 7
Reviewer/Inspector 5ignaturi j Date:
Page 3 of 3 4/Z 11

Type of Visit (ompliaince Inspection O Operation Review O S#ructure Evaluation O Technical Assistance
Reason for Visit Q o%utine 0 Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 'Z S'/O Arrival Time: /4.'Q $,a Departure Time: 0: 2SA... County: s�� sa "` Region: -12'20
F/�` '
Farm Name: A � �iy�`S�+iiR.S Z- Owner Email:
Owner Name: RYI/R N Ale -115 Phone:
Mailing Address:
Physical Address:
Facility Contact: CAr �r rwi t/L Title: 1 u-� • w Phone No:
Onsite Representative: s rwri Integrator: �/'� SAF J5J-0 ,
Certified Operator: ' t✓ O� �614 Operator Certification Number: %/�
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 0 [=' ED"
Longitude: 0 0= i=
urrentpulation
sm
❑ No
ETN --A
❑ NE
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
[:]Layer
El Dairy Cow
ElWean to Feeder
❑ Non -Layer
I
[I Yes
El Dairy Calf
® Feeder to Finish 7L]
❑ NE
El Dairy Heifer
ElFarrow to Wean
Dry Poultry
El Dry Cow
ElFarrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
ElTurke s
Other
=E1:10
❑ Turke Poults
❑Other
Number of Structures:
er
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
ETN --A
❑ NE
El Yes
No
ElL�
'tvA
[__1 NE
E3<A
E] NE
❑ Yes
El No
[I Yes
B No
❑ NA
❑ NE
❑ Yes
B o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 82 - Date of Inspection 3 -ZS -/O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El"No ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes O<o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .:i] / Z
Spillway?:
Designed Freeboard (in):
Observed Frecboard (in): Z Y 20
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
R<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed El Yes
,�, /
10 ❑ NA ❑ NE
through a waste management or closure plan?
E o
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
7. Do any of the structures need maintenance or improvement? ❑ Yes
ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L"1 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
18. Is there a lack of properly operating waste application equipment?
Waste Application
BNo
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
CfNo ❑ 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 l0 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) 'Fer-'V 0 e" , Ssc�E ll Cv vt;� 6"5-') 6" -
10
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
31-
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Efo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
D i\ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
BNo
❑ NA
❑ NE
Comments (refer to question`#) Explain anyWYES�answers andlor any recommen�atians or any other comments.
P
g tuations h(use additional pages as nevess a' ,
of facie to better explain std
Use drawings s ` .
Reviewer/Inspector Name �j�j ewtf5 Phone: %1,9. X33.3300
Reviewer/inspector Signature: Date: Z -Zar-20/0
11/28104 Continued

FacilityNumber: S2 - 9 Date of Inspection 2-25'-/0
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
❑ Yes [5 No ❑ NA ❑ NE
❑ Yes LR'No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L3No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [I Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections E] Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
oo
El NA
El NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,LT,
L1 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O -No
ElNA
[:1NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElE Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EKo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CYNZ
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
'
O_Ko
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9<
❑ 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
Ehlo
❑ 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
0'o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
,� ..,,�
EKo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0'lvo
❑ NA
❑ NE
Addihonal�Commien#�and/o"�Dr ngs:
12128104
12128104

8ptr G,v u.cd 10 - d Z — o S
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: O -O/-Oq Arrival Time: ; 20 Departure Time: �,I �5�,,. I County: S4�,Q Son/ , Region: l��
Farm Name: i'Q/afovi-e-4 �^�� �:., � Z Owner Email:
Owner Name. ge" ,C^/ LAJ` f �5 Phone:
Mailing Address:
Physical Address:
Facility Contact: l(e#s Title: r-ee­c/- Phone No:
Onsite Representative: ►✓7�_S ga.-�..+''4� Integrator: '00re_5A� F4
Certified Operator: �L'— t �� Operator Certification Number: Z'$ 7G•4
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o = ' E�] Longitude: = ° ❑ ' ❑
Design Current
Design C►arrant
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
[3'NA ❑ NE
❑ Dai Cow
El No
❑ W an to Feeder
, ❑ Non -Layer
❑NE
❑ Dai Calf
Q'tvo�❑ NA ❑ NE
NrFeeder to Finish 3720 �"
El Dairy Heifer
El Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
❑ Non -Dairy
to Finish
❑ La ers
❑ Beef Stocker
JE]Farrow
❑ Gilts
on -Layers
El Beef Feeder
.
❑ Soars
Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
DischaLges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 3_110�1:1 NA EINE
❑ Yes
❑ No
L—i,I A ❑ NE
❑ Yes
[:1 No
LTA ❑ NE
[3'NA ❑ NE
❑ Yes
El No
❑ yes
t=No❑NA
❑NE
ElYes
Q'tvo�❑ NA ❑ NE
11/28/04 Continued

Facility Number: Date of Inspection
Soil type(s)
Waste Collection & Treatment
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,,��,,�
L_ti'1Vo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ETNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
21 o ❑ NA
❑ NE
Structur �1 Structu� Structure 3 Structure 4
Structure
5
Structure 6
Identifier: �/
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
Spillway?:
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in): 31 3 i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B o
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
❑No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
L�'T�No
❑ NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
E] Yes
L_I 1-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
[2<o
❑ 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 2 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 Area
12. Crop type(s) ?__' G° "...w C' (14', ) s+^� d %. S.) Ce VXf - t...s L, f - SQ.7 b <4¢
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,,��,,�
L_ti'1Vo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
& o
❑ 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
ffNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
EK
❑ NA
❑ NE
Comments (refer to question` P y y� k y$ mems.
Eg Iain an YES'answers andliir an �recammendahtins or an other com
Use drawings of facilityto better explain situations. {use additional pa'VOR-6-
Reviewer/inspector
es as necessary}:
v 'VO • r
Reviewer/Inspector Name Phone: CPO. 433.333 Y
Reviewer/Inspector Signature: T Date: j0 -,0/- 2 00 9
12128/04 Continued

Facility Number: 82 - 49 Date of Inspection a -off -b q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [I Design [I Maps [I Other
❑ Yes No ❑ NA ❑ NE
❑ Yes I34O ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ca'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 1"
Rain Inspections El Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Bo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNoo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ErNoo
ElNA
[:1NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
LTJ No
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NZo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
E] Yes
,r
E o
[-INA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B go
❑ 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
L7 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
0<
❑ 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
34-6_
El NA
[__1 NE
33. Does facility require a follow-up visit by same agency?
[__1 Yes
hs,
2<6 ❑ NA
❑ NE
A dition`�al Co meats andlor D_ r�a�v�ngs:
•
El
12/28/04

$;70(S eojA#- cJ- 9-/7-07 se.2-
0 Division of Water Quality
Facility Number0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ®Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: -/ -Q Arrival Time: 2 : oo Departure Time: 2 ! .n County: S_<±e_SO N Region:
Farm Name: t'c_ pi , --T-4 lv Z
Owner Email:
Owner Name:tt ✓., +Iv Fa/ 7�a t!r 4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Fa.1S;fbe-( Title: Phone No:
Onsite Representative: C i, %,_ i- i s. Integrator: C-0 u1, a.V 1 0---. �a t- L✓� S .
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' ='
= Longitude: E:1 o =,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 372- a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ E:tults
ke
❑
Turkey
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: a]
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 LY No ❑ NA ❑ NE
❑ Yes
[ANo
[INA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
[INA
❑NE
❑ Yes
�? No
❑Yes
5dNo
❑NA
1:1 NE
❑ Yes
0 No
❑ NA
❑ NE
12/28/04 Continued

11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Co No
❑ NA
❑ NE
Facility Number: �Z- q Date of Inspection
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Waste Collection & Treatment
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�j No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
qj No
❑ NA
❑ NE
Spillway?:
Does the receiving crop and/or land application site need improvement? ❑ Yes
� No
El NA
[:1 NE
Designed Freeboard (in):
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[)] No
❑ NA
❑ NE
Observed Freeboard (in):
Does the facility lack adequate acreage for land application? ❑ Yes
1P No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
21 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
a No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Co No
❑ NA
❑ NE
Reviewer/inspector Name Rick., Phone:
❑ 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 W'' iiind Drift El Application Outside of Area
12.
Crop type(s) e�:,, r+�l1t t ,.1L4,4 Sam.,
be t^fS
13.
Soil type(s) _ lv'-AJIK
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
qj No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
� No
El NA
[:1 NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[)] No
❑ NA
❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Yes
1P No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft 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 Rick., Phone:
Reviewer/Inspector Signature: Date: 9 - 3 - 2_00-7
12/28/04 Continued

aJ �
Facility Number: gz, — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
[XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit B Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 5-03-06 1 Arrival Time: 1:30 Departure Time: County:•.. Region: FKQ
Farm Name: — /-cx lc -f0 J -T 4,1.z Z Owner Email:
Owner Name: 1"7AI-A V, cLt Phone:
Mailing Address:
Physical Address:
Facility Contact: /14i7v5Lict // F A-1,6 J�',-4 Title:
Onsite Representative: CIAV44_5 tJcaV-WiC-n'__
Certified Operator:
Back-up Operator:
Phone No:
Integrator: �0 t'r, ; 'k -
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [::]'E::]'
[=] Longitude: [�o a' ="
�
Deng Current
Desigti
Current �,' p Designnt
Swine
Capac ty Poptilatetin Wet Poultry
Canactty •Population Car#tle C•apac 4ty Population
❑ Wean to Finish
< ❑ Layer
L1 Dairy Caw
❑ Wean to Feeder
`- ❑ Non -Layer
_'❑ Dai Calf
® Feeder to Finish 13j'';.;
'7 Z O j Z O'
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
E3 D Cow
El Farrow to Feeder
❑ Non -Dairy
El
El Beef Stocker
El Feeder
'. El Brood Cowl
Uther K 3 k rx t
❑ Other
Number of Structures:,®
Farrow to Finish
❑ Gilts
❑ Boars
Discharges
&Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes (9 No El NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? ❑Yes ®No [-INA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ®No ❑ NA El NE
c. What is the estimated volume that reached waters of the State (gallons)`?
d. Docs discharge bypass the waste management system`? (]f yes, notify DWQ) ❑Yes [A No El NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes ®No [__1 NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes ER No ❑ NA El NE
other than from a discharge?
12/28/04 Continued
El Layers
El Non -Layers
El Pullets
El Turkeys
❑Turke Poults
❑ Other

Facility Number: gZ -- Date of Inspection
Crop type(s) Be rm'AA o._. �6!4 Srvva 1 t Gtr; i.J Ctc-rJ tA.-_
.5c, toQ'X'iS
Waste Collection & Treatment
_
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ffNo ❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NA
❑ NE
IS.
Spillway?:
❑ Yes
No
❑ NA
Designed Freeboard (in): t aJ _
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
E] Yes
Observed Freeboard (in): !t
❑ NA
❑ NE
17.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[WNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
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
[59 No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[4 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
mai ntenance/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 Drifl ❑ Application Outside
of Area
12.
Crop type(s) Be rm'AA o._. �6!4 Srvva 1 t Gtr; i.J Ctc-rJ tA.-_
.5c, toQ'X'iS
_
13.
Soil type(s) NO r^{"e I K
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
['A No
❑ NA
❑ NE
IS.
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',
E] Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
-E,x . Wn:ani
iefteryeplain situ
Reviewer/Inspector Name �R i:� }C. . 2_e 2 15 ;; °� A Phone: (efla) '5zz --15V I
Reviewer/Inspector Signature: ��— t�e.l-i Date: .5-03 - zoo
12128/04 Continued

Facility Number: TZ _9 Date of Inspection-o3-CCa
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ElNA ElNE
the appropirate box. ElWCp ElChecklists ElDesign ElMaps [IOther LP
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Y No ❑ NA EINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
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 pen -nit?
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?
❑ Yes
5No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
El Yes
No
0 N
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[;I No
❑ NA
❑ NE
❑ Yes
(UNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
aaamnaiWCom ntsandlur.Drawings
y •' .�
a $ ` r'q°
,' `
12/28/04

Type of Visit O'tompliance Inspection O Operation Review O Lagoon Evaluation #
for Visit GoKoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number q' -
Date or Visit:
.`� Time: �: pry
Q Not O erational O Below Threshold
Permitted CKertified 0 Conditionnaally Certified © Registered
Date Last Operated or Above Threshold:
Farm Name: ...........1 a DV �. .... ...F-011SN, # -1
County: _........ '
._
!--T­---------­­
Owner Name:m Ai�4b✓fCn
....
� -T._ ._.___ .._._._._
PhoneNo: � _
Mailing
Mailing Address:..M �� �x�K� _ ..' be-i'V&................... .
Facility Contact: �f! r�F1 4`�►
.._.,........._......._...._.... ......... �.............. Title:_............��►.'IC.+e.........,_------_.... Phone No:_�......_......_----�---.................
Onsite Representative:...._ _-% . 4Sl�Se _ - -_ _._
Jam, ,, .
Integrator. �-- Cq&- �--•----- __ ..._..
Certified Operator:._. AlW&JI .�.__.. ��;`b vs� W
Operator Certification Number:
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 &4 Longitude ` 4 44
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?[
❑Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [jhio
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [4o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struct e 1 Structure 2 „- Structure 3 Structure 4
Identifier: _......................------
*........oZ............
... ....._ .....
Freeboard (inches): as
12112103
❑ Yes [Wo
Structure 5 Structure b
Continued

Facility Number: — 9 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ElWo
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes [Wo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 21go
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes 52 -No'
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑moo
I 1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Gwo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type .Sd' ojh "5'V%41j" oisf a� cA"+
13. Do the receiving crops differ mAth those designated in the Certified A&W Waste Management Plan (CAWMP)?
❑ Yes
[ oNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
M -No
b) Does the facility need a wettable acre determination?
❑ Yes
[qqNo
C) This facility is pended for a wettable acre determination?
❑ Yes
MNo
I5. Does the receiving crop need improvement?
❑ Yes
3090
16. Is there a lack of adequate waste application equipment?
❑ Yes
ERIC
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes
91N0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
940
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
El Yes
M K0
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
❑.moo
Air Quality representative immediately.
;COmmw1LS {�cefer tAr questeoa 11`) � Explain any YF.S aasWtrS and/or alrry recommendattans ar au Rather, commeats. - s
;Use drvvuags� of fac�ty to better explatn�sttttab�. (nse addittnnall pages as nexexsary) �eld COPY ❑ Ftnal Notes � '
Cor
Reviewer/Inspector Name ]4 9 s
:... i� 9
Reviewer/h%spector Signature: Date: d
12112103 Continued

Facility Number: Date of inspection ;t
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 &Kreeboard [B<aste 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?
N'PDES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes EiM-No
❑ Yes [Wo
❑ Yes &?No
❑ Yes POSo
❑ Yes UNo
❑ Yes @oho
❑ Yes E090
❑ Yes MoNo
❑ Yes EgoKo
21es ❑ No
❑ Yes [aWo
❑ Yes EiNo
❑ Yes JgNo
❑ Yes Edo
❑ Yes &No
Er No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
dditionaFCortiments-aad/ar Drawings
air, A
j
r
12112/03

7 , _ Site Requires Immediate Attention:
Facility No. _e2= 71
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 77 IZe 1995
Time:
Farm Name/Owner: TC��� - - -
Mailing Address: ED
County:
Integrator:
On Site Representativ4:
Physical Address/Location:
Phone:
Phone:
Type of Operation: Swine Poultry Cattle
Design Capacity:Number of Animals on Site: 6 6==L-1
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: '
Circle Yes or No
Does the Animal Waste Lagoon h e sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray?e br No
Crop(s) being utilized:
Actual Freeboard:_,q_Ft. Inches
Yes or(g)was any erosion observed? Yes- or(o
Is the cover crop adequatelQji0or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweilin s? YY No
100 Feet from Wells? or o
Is the animal waste stockpiled within 100 Feet of USGS B1ue.Line Stream? Yes orV
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ofQ
Is animal waste discharged into water of The state by man-made ditch, flushing system, or other
similar man-made devices? Yes oi(,No If Yes, Please Explain.
Does the facility maintain adequate waste management rec r (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop). Y or No
Additional Comments:
.JOA:�5� LZ4" A,_� ���
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

- Site Requires Immediate Attention: -- a
Facility No. Z
inliS �lV
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 , 1995
Time:
Farm Name/Owner: pr e sAge Fa --5 % J C /OaPe.
Mailing Address:
County: - — - - - - - -
Integrator: Phone:
On Site Representative:'Z. 0.� - rrt�� I �� Phone:
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle _
Design Capacity: 1 14 C z') 2 A , . Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: '
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (Gi or No Actual Freeboard:_ 9 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or (@)Was any erosion observed? Yes or
Is adequate land available forray?�e or No Is the cover crap adequate? es r No
Crops) being utilized: - .bV' r r, ud5 _ ._ -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? � or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue.Line Stream? Yes or fiiD
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or l&o
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o(�___' If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?a or No
Additional Comments: .wt :A, �ql =12
J otA nn of _ �Z. !7 w.��t�- �e �rrN 42
h4r !es 14 JVartz-
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTH CAROLINA UHPARTMENT OF ENVIRONMENT, B$ALTS& NATMIAL RESOM ES
DMSION OF ErN ONMM AL
Fayetteville Regional Office
Animal Operation Compliance mnspecticn Fora
'
'IEiN
a:i'`gFtlri PUi�lO�Tl�1�. ;"4A
73dS ;I?ATi $1�itis N�BR:
C
:..�.
,yAa
�W�� 1Ti .' ...H.�_0..:.N-am¢
y1Y
0 I� cle.6
i bn 2937-A-�9l
5 a43567
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
imal Operaktion : � n 1, sh'i h
Horses, cattle, wine, poultry, orJsheep
SON ii
Y i N i COMMENTS
1. noes the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
2. Does this facility meet criteria for
Animal Operation REGISTRATIO ?
3. Are animals confined fed or maintained
in this facility for a 12 -month period? -
4_ Does this facility have a CERTI'F� SAL
WAS TL , MANA9Xk9 'P MA -W
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
5. 'Does this facility tweet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

. sgcrxce� zz= '
Y t� Commas
i ld ite !Barra anent
1, Is animal waste stockpiled or lagoon
construction within 100 ft. of a USG5
Map Blue Line Stream?
7. Is animal waste land applied or spray
Irrigated within 25 ft. of a USGS Map
81ue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
Cover crop in accordance'with the
CERTIFICA'TIO nL .
5. Is animal waste discharged into waters of
the state by maxi-made ditch, flushing system,
or other similar man-made devices?
6. Foes the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved [:MTTFICATION?
7. Does animal Waste lagoon have sufficient
freeboard? How much? (Approximately }
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
5EMON TV
Comments

h
"' rr 4
J to
a4L V a
ILL
Ira ,.+4 45 r
IV SZ
Ole
oil .
' J iP. ^ ~ ''
n � r � � •i � � X17 '�. � O .. _

' � Y
REGISTRATION FORM FOR ANIMAL FEMOLOT OPERATIONS
©enartment of Environment, Health and Natural Resources
Division of EZv__onmental Management
Water Quality Section
if the animal waste management system for your feedlot operation
is
designed to serve more than or
ecual to 100 head
or cattle,
75
ho=ses, 250 swine, 1,000 sheep, or 30,000 birds that
are served
by
a liquid waste system, then this
yc= must he filled
out and mailed
by December 31, 1993 pursuant t_
15A NCAC 2E.0217 (c)
in order to
be
deemed permitted by OEM. Please
pint clearly.
Farm Name: L _
Mailing Address:
County:
Owner (s) Name:
:tanager (s) Name:
Lessee Name:
Farm Location (Be as specific as ossible: road names, direction,
milepost, _etc .) : rt � 7 I (3 :S c u KAY- H MV LEX�
Lat_tudelLongit::de if known:rN
;�1�5TP I `�` I
Design capacity of animal war*e management system (Number and type
cf confined animal(s)):WT
Average animal population on t_ a farm (Number and type of animal (s)
-raised) ��
_ �1i15 41FOON-
`
Year Production Began:/29S RSCS Tract No.: 1� '7a3
Type of Waste Management System Used:_�.��, )%-\ • N_
1G! (
s
Acres Available for Land Application of Waste: 7_
Owner (s) Signature (s) :
: '7 2? 93
DATE:
A

,y
l

WE CARE
Amstaw WE USE
J PE
WC. POPE
3237J -CLEAN AIR