820112_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

5� —3 —
(Type of Visit: UCo�ance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: er, routine 0 Complaint 0 Follow-up 0 Referral 0 Emersencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: i Departure Time: Q County: Region:
Farm Name: -+4�1 �N 7'�t'h'�.S ,� �-.3 Owner Email:
Owner Name: �,,, ,,t ; rd dig �� Phone:
Mailing Address:
Physical Address:
Facility Contact: 120 P7h, r- Jjrr- Title: 4peds Phone:
Onsite Representative: �'��`� Integrator: ��yrr
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Fop.
Cattle
Capacity Pop.
Wean to Finish
Layer
I
airy Cow
Wean to Feeder
I
jNon-Layer
I
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
i)r P.oultr,
Ca acl
F.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
r=Other
Turke Poults
Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance nian-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters'
of the State other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:)No
❑NA ❑NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes fo ❑ NA ❑ NE
[—]Yes fo ❑ NA ❑ NE
} 21412013 Continued

Facility Number: - Date of Inspection: 2—ILV Tr
Waste Collection & Treatment
t. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [3 Yes No F-] NA 0 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):—
Observed Freeboard (in): #6-,3,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E]'�lo ❑ 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" No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �o D NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�o ❑ NA ❑ N E
(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 [Er o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2�'I�Io ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes do ❑ 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): r"14,4 Gt I l) V 'r't"d
13. Soil Type(s): 2"
14. Do the receiving crops di from those designated in the CAWMP?
❑ Yes
to
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Efl�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[21-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�J<
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Dlo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
2] 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 [Ej<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste "rransfers ❑ 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 Q-14 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3 o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Ins ectlon: — 0-- /ff
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
ti 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 13<0 ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes E No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E:j"*No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes [J'No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes EffNoo ❑ NA ❑ NE
❑ Yes [E No ❑ NA ❑ NE
❑ Yes ��o❑ 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).
A &W n7-
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone: :3D.3 D/sr
Date: �'„3 o
21412015
Page 3of3

/7
(Type of Visit: EMom a Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: Arrival Time: O 0 Departure Time: ( County: , egion:
Farm Name: �g��j rd' -�G r'P7?S %� f'3 Owner Email:
loor
Owner Name: d /fJ l'1 �'l�i !� f `a h � Phone:
Mailing Address:
Physical Address: ` Q
Facility Contact: ✓ t- r :3f-A ,5r%' Title: ©GyYI` / Phone:
Onsite Representative: Integrator:
Certified Operator: C
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Swine @opacity
Wean to Finish
Current
Pop.
Design Current Design C►urrent
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
llesign Current
D Cow
Farrow to Feeder
Farrow to Finish
Dr, I;oultr, C•a aei P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other19L
Turke s
Turke Poults
Other
Dischar es and Stream Impact
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ®, No
[-]Yes C5-No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facill Number: Z2Z 1 Date of —Inspection:
Waste Collectlon & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3 _ , L3 �/Z_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ &No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes §Z No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
1Z 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3;_n/mmo� d vr�Ster_ _
13. Soil Type(s):
14. Do the receiving cropsidiffer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
T�f�Jr
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes JR� No ❑ NA ❑ NE
❑ Yes KNo [] NA ❑ NE
❑ Yes [E�No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes Z,No ❑ NA ❑ NE
❑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 Q� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes „� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 13—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fait to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes � No ❑ NA [3 NE
❑ Yes SNo ❑ NA ❑ NE
❑ Yes g,No ❑ NA ❑ NE
❑ Yes [Z No
❑ Yes allo
❑ Yes Eg.No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone: }2 0-9!�703-a/.-1
Date: ?— / 3r41 2
21412015

i"vi"slop of Water Resources
Facillty Number � - © � Division of Soil and Water Conservation
� Other Agency
Type of Visit: 19nomplianceinspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up O Referral O Emerizency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; pD Departure Time: County: Region: Ry
Farm Name: Tjr s r/- t-o-rms 4
Owner Name: ;22'zg ; Z j���S�y�—
Mailing Address:
Physical Address:
Facility Contact: ;22rd I? i e Title:
Onsite Representative:
Certified Operator: -:57"&�
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pvp.
Wet PouMy(,apacity
Pop.
Cattle Capacity Pvp.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Q
DairyHeifer
Farrow to Wean
Design
C■urrent
D Cow
Farrow to Feeder
D_r, P■oultr,
Ca aci
P■o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Puilets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes allo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑ Yes [:]No
❑ Yes [&No
❑ Yes kNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection: b
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes 0 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
RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public
health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2, 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
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
r No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
®-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy
Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
Crop
12. Type(s):dc
13. Soil Type(s): yn %paw
14. Do the receiving crops diffe from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
;NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;. No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
�5NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
CE�NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
C&NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
I&NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Jallo
❑ NA &N E
❑ Weather Code
❑ Sludge Survey
DNA RNE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
M.NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
T§Oo ❑ NA
P4 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA
P NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA
ONE
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?
Dyes 5gNo ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
Yes ❑ No
,Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
f�rn' _ �wvr -4- the .5 i7 7oc1 ram., r7 aQ' 74e_ -` ar-v u,Gs
oeYL Do�
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: 9/Z) 4,3.3-3__5EV
Date:
21412015

W't"sion of Water Resources
Facility Number ®- © Division of Soil and Water Conservation
Q Other Ag!LneIII
Type of Visit: ompliance Inspection 0 Oper tion Review 0 Structure Evaluation Technical Assistance
Reason for Visit: outine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; is Departure Time: ' County:
Farm Name:%31 Sr/ warms % , .� d- 3 Owner Email: �—
Owner Name: Phone:
Mailing Address:
Region: �_� Q
Physical Address:
Facility Contact: n; Y &JZ2rr Title: Phone:
Onsite Representative: G<-:.tom Integrator: _5 / -`'/'/
Certified Operator: Certification Number: 6 S-fI
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
11
I I Layer
Dairy Cow
Wean to Feeder
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. POE It
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
urke Poults
Other
Hother
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA kNE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA RNE
❑ NA R_NE
Page I of 3 21412015 Continued

Facility Number: - / Date of Inspection: r—
Waste Collection & Treatment
" 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No NA ;!�_NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): IV
Observed Freeboard (in):_ )vri— —4=
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA MNE
(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
E&JNE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
MNE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
5LNE•
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
� NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
[ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g 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): Z �Jjd r�I"Ls "'j
13. Soil Type(s): 1�21L��cC2 _ / ,�, �' /` , l Y✓J i y f/ �F llr_ /Z_
14. Do the receiving cropsvdiffer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
�] Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes
" No
❑ NA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes �a No []NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes C,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? C] Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

' Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
�r
❑ Yes
3 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
F No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
CgNo
[DNA ❑ 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?
Coniments (refer:to question:#): Explain'any YES gnsw.er
Use drawings.`of facility to' -better explain situations (use-ai
x-cords 7-0 d
7
Reviewerllnspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Iditional pagmasrnecessary).
6U f / � Ne'°t�sh
❑ Yes CANo ❑ NA [] NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes 2S No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
[] Yes EA No
❑ Yes CO -No
❑ Yes allo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
is or, anyroth r continents.,
Phone:
Date: �"'���®� f 6•
21412015

A.
Kn
G - �- -�'S
j ype of visit: vo-tompnance inspection v uperanon xeview V Ntructure evaluation V i eennicai Assistance I
Reason for Visit: 01 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L—�16 Arrival Time: ; D f7 Departure Time: r D County:_��
Farm Name: t 4- Owner Email:
Owner Name: �� ,•� i r_ Pad Sh �/ Phone:
Mailing Address:
Physical Address:
Facility Contact: ,,,, �- f-- 4S r/ Title: /j CcJg,. r Phone:
Onsite Representative: Integrator: /y! 0
Region: '�'7 n
Certified Operator: ; y�'cs,._� Certification Number: b
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design
Capacity
Current
Pop.
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Current
Pop.
Wean to Finish
I JLayer
Dair Cow
Wean to Feeder
I iNon-Layer I
lf
Feeder to Finish
I Dairy Heifer
Farrow to Wean
Evesiffn Current Dry Cow
D_r, P■ouitr Ca aci _ Pao Non -Dairy
Layers Beef Stocker
Nan -La ers Beef Feeder
Pullets Beef Brood Cow
Turke s
urke PoultsOther
Pother
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Discharges and Stream_Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes P-No [DNA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes �No
❑ Yes Q�[No
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

[Facility Number: - Date of Ins ection: 4�, /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): 9,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
0,No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑Yes ®No ❑NA ❑NE
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [} No
❑ NA]
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes S No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Callo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®, No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EQ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes fo No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: a2z - / Date of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes IU1 No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (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?
[3 Yes ®No ❑NA ❑NE
[:]Yes Callo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
[]Yes S No ❑ NA ❑ NE
❑ Yes ®. No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question,#): Explain any YES answers.and/or.any additional recommendations or any other comments.
use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: j�-3300
Date: r✓ - 3 v-2D C
21412011

A �
Urbivision of Water Quality �.� 13— 13 L/
Facility Number ®- / l rZ 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: omInspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
C�K
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other ( Denied Access
Date of Visit: Arrival Time: '. 3 Departure Time: J `, County• Region:�
Farm Name: r�r �p,ayy�3 j & 3 Owner Email:
Owncr Name: �fj rl vl i r_ rO�o� $ h r. '`� Phone:
Mailing Address:
Physical Address:
Facility Contact: 'DHn ; 2:�. �ro���� Title: [Lj�?r_ Phone:
Onsite Representative: �'lc.�..�- integrator: AU (,04__.
Certified Operator: S'�-..� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
]Layer
Non -La er
Non-L
Pullets
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes allo ❑ NA ❑ NE
[:]Yes []No
[-]Yes [-]No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes C5 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [2!�No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: I y Date of Inspection:
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): (9- 91` k 9-
Observed Freeboard (in): 7 3 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EKNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
r"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
54No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ 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
g!;-No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes QR�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): ,/Ajz►r`pyludl� /Yri�
13, Soil Type(s):
4-
14. Do the receiving crops Affer from those designated in the CAWMP?
❑ Yes
allo
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P! No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MI
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C!-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
D 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
M.No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®-No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

` Facili Number: - Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �allo 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [&No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes rn"k No ❑ NA ❑ NE
❑ Yes CK'No ❑ NA ❑ NE
❑ Yes C„No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes rVI No
❑ Yes 4'No
❑ Yes CNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:yQ y.-
Date;
21412011 L

9
iAsion of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r1� Arrival Time: ; 0 0 1 Departure Time: ', ^ County: Region: ��
Farm Name: Ora j,rL,,,- Pd/rrtS 3 Owner Email:
Owner Name: Wi v7 k? i Phone:
Mailing Address:
Physical Address:
Facility Contact: 1r�pl�iyt t-z-- z Title: Phone:
Onsite Representative: �'1�.�� Integrator:
—o
Certified Operator: � .-�- Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish r
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Daig Cow
Dai Calf
Daia Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[] Yes ;S No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
[-]Yes
gLNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

}
Facility Number: AiL - / Date of Inspection: t]--
�. Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ C�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19 /q r
Observed Freeboard (in):7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes * 5kNo ❑ 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 Zi 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 R[ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 eEER No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J?jNo ❑ 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): 4J ior'n a r,'J
13. Soil Type(s): yp// L
e­
14. Do the receiving cro s differ from those designated in the CAWMP?
❑ Yes
[g, No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LC6LNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Callo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 [. 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 0] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CE No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[3 NA ❑NE
Page 2 of 3 21412011 Continued

• Facili Number: jDate of Inspection: — p —
`. 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[&No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
�&No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
� No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[4 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
5No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ (�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
a
Page 3 of 3
Date:
21412011

dEMivision of Water Quality f�
Facility Number ®- O Division of Soil and Water Conservation $._IL 7-- jy
0 Other Agency
Type of Visit: ce Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ;o�'U't"inle O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �j -Arrival Time: Departure Time: CountYL92 ':r_ Region:
Farm Name: hr-1 i evm Owner Email:
Owner Name: UD 6 rr� i G Phone:
Mailing Address:
Physical Address:
Facility Contact: 0,9ptri 5;)L .' Title: jp ple�r Phone:
Onsite Representative: 6 e".� _ Integrator:
Certified Operator: C 5�! Certification Number: �z �-
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream lmnactsand Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 56,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [::]No
❑ Yes �No
❑ Yes L!3-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facilit Number: Date of Ins ection:
Waste Collection & Treatment
"'1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: Q
Designed Freeboard (in):
Observed Freeboard (in):�7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Uj 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 [3 NA [3 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 [g No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes IM 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes INNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below, ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 7
e -�
�i 0'•"�
14. Do the receiving crop iffer from those designated in the CAWMP.
❑ Yes
CEg-No
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
(, No
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[5�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ 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
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 FNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If' yes, check ❑ Yes Z�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency`?
❑ Yes
� No
❑ NA
❑ NB
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes
23-No
❑ NA
❑ NE
[]Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes S-No [DNA ❑ NE
❑ Yes gNo
❑ Yes 2�No
❑ Yes ,.Dlo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andhir any additional recommendations -or any other:comments.
Use drawings of facility to better explain situations (use additional: pages as necessary)._;;r
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Phone: Jlffa-33Do
Date: �?--�� _z;;;10 11;2-
2/4/2011
Page 3 of 3

h.
IEMivision of Water Quality
Facility Number ®- /�- O Division of Soil and Water Conservation_
O Other Agency
Type of Visit: OTompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: p Departure Time: County: tr•— Region:
Farm Name: E•r'' 3__ - Owner Email:
Owner Name: D,7 ✓1 j r Z raed Aw e— Phone:
Mailing Address:
Physical Address:
Facility Contact: Obn hie 15/'CX(a Title: O war #,` Phone:
Onsite Representative: ,jga„,L _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator: J9jG�j
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
aa er
Non -Layer
Discharees and Stream Imnacts
ury rouirry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Daig Heifer
Cow
—Dry
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
JR No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: J2 - 4.Date of Ins ection: /
r«
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No 2LNA ❑ 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):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2S 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? 01Yes 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ®, No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
U Yes
L},No
U NA
U NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
&No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C,No
❑ NA
❑ NE
the appropriate box.
❑ WUP [--]Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ 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
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: jp Date of Inspection: /
�r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? 1f yes, check ❑ Yes CRNo ❑ 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 chargc?
❑ Yes
EZ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ED 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes � No CD NA ❑ NE
❑ Yes M No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments;
Use drawings -of facility to better explain situations (use additional pages as;necessar ).
f"r or�N'" beery B�e"�• �7...�� �'�z-v-r--�— -�/�s 1� --�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:19L
Date: Z=
21412011

rvision of Water Quality 4--1—f D
Facility Number ' O Division of Soil and Water Conservation
a__ O Other Agency
Type of Visit Gecompliance Inspection 0 Operation Review' 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O'go—utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rr,,��-~ __ ii~ro11 Arrival Time: ;'p Departure Time: ��' County: !J'-`� Region: D
Farm Name: ;TXad�SrswI Owner Email:
Owner Name: I)D +•1 in 1 r__ C96 Phone:
Mailing Address:
Physical Address:
Facility Contact: _Q ri o,; 1 , 1CLJj Title: 91.ii n r,r Phone No:
Ousite Representative: "S'®�� — Integrator:
Certified Operator: Operator Certificat' n Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ b 0 I = H Longitude: ❑ ° 0 I 0
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feederto Finish 1.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer I
----...._._.�
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: �J
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 RNo ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
U.No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
Page I of 3
12128104 Continued

1
r
i
i
Facility Number:
Date of Inspection 6—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: ^, -
Designed Freeboard (in): 1
Observed Freeboard (in): S�-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ;KNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W1 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
®No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Pond ing []Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) z der1�2zz
13. Soil type(s) l.0 /�aeuk l w i 4,4 5ef1m_Az, / ku Q sip •- .4" �
14. Do the receiving crops differ from those designated in the CAWMP? / ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
KNo ❑ NA ❑ NE
C&No ❑ NA ❑ NE
Comments ,(refer to question #):. Explain any YES answers Pandtor any recommendations or any, otherrccomments
:.Use dfAwings of facility to°'bei tterexplain situations. (use additwnal pages as,necessary)
4�tl 1� � kE Pa
1W
ReviewerlIns aF ,'s ; r 4
Reviewer/Inspector Name
p v r: r r
Phone:
}-
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

'A Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
S No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
51 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
BNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;SNo
❑ 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
I@ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CgNo
❑ 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
$a No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
gLNo
❑ NA
❑ NE
Additional ,Cnrnments antl(i►r. breivings;'. +.'h iir
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

ez'ivislon of Water Quality
Facility Number �� , �� O Division of Soil and Water Conservation
0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / lArrival Time: rD(� Departure Time: l r County: O'er` -Region:
Wo
9(111
Farm Name; d3 r Gr.�L, r✓' ��xt.. 1� Jd` 3 Owner Email:
Owner Name: DU n n ". 1e 1` ���( d'Sh �►r Phone:
Mailing Address:
Physical Address: II
Facility Contact: Title: �PT'Zsy-+p ✓ Phone No: 3YS y g
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = 0 = 6 ❑ Longitude: = ° =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Non-
urkey Poults I— —
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ DaiEX Cow
❑ Daiix Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ZI
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 9jNo ❑ NA ❑ NE
❑ Yes 5 .No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection ®O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes JKNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?;
Designed Freeboard (in): 42! 1 9-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [SNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Q�No ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [$-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ® Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 No ❑ NA ❑ NE
maintenance/improvement?
I. is there evidence of incorrect 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 Area
12. Crop type(s) j v:►l =-,r j
/� t ` ' ,,�-I
13. Soil type(s) Iill rr.wJ2t-.� �{%d iJt.s %11� [.tjPC /Y�Ile V.,.� 17at�+4 1GLt d ! A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
RC No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
5 -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
59-No
❑ NA
❑ NE
. .. .. _ �;Ci31�hba.'�& .�������
Comments (refer to question #): Explain any YES ansvvers and/nr any r,"ecummendations�or any"other{ comments Y ,
Use drawings of facility to better explain situations. (use. additional pages as necessary)'
a
01
Reviewer/inspector Name -- - �- - NO?d.c
fi '. Phone: `}`/D
Reviewer/inspector Signature:
Date:
/ F 12128104 Continued

Facility Number: — Date of Inspection ICJl,g�'
1
' 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 [S�No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[--]Yes
[RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
' ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
BNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1�9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9.No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2!�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
RNo
❑ 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
5� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
-2LNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
t&No
❑ NA
❑ NE
12128104

vision of --Water Quality
Facility Number 6 Division of Soil and Water Conservation
Q Other Agency
Type of Visit
ompllance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
E � outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: [ Departure Time: 00 1 County: Region:
Farm Name: _, 4LL_f'___ACAL, j Owner Email:
Owner Name: ,x,—, Phone:
Mailing Address:
Physical Address:
Facility Contact: SL2 elh % Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 4
Operator Certification Number: .Z�1 112?21
Back-up Certification Number:
Location of Farm: Latitude: =' 0 ` 0" Longitude: = ° =' =
Swine
❑ Wean to Finish
❑ Wean to Feeder
EM Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feedei
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er -
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
ElDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
El Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
a No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % 9"
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes JZ No ❑ NA ❑ NE
through a waste management or closure plan7
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 0 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 O No ❑ NA ❑ NE
❑ Excessive Pon ding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,7�&r-M u a, / ,('jUz'L.5e' d
13. Soii type(s) �i/Q., r� / 7,-9rn0, IAu/lt /Al-o"Vv; 11_. / L �Vhh /Arv"N �Ll rii'✓1 n� �1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
M. 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
M-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DINo
❑ NA
❑ NE
.5,L�b�'i�,:�w�,.:.,�'%is'��7:P�s,-.'�i�.'y� �
Comments (refer toquestion #) >Jxpleinany YEStanswers and/or�ay, recommendations or any ofher'comments.
t * z ss �, � . � aF:t,
Use drawingsof facility�tojbetter expl1l�aln situatlonsr!; Mse additlonages as necessary,): .
'h!M,istl+!F+,44F,i .4'4ki4ia,='lf9`�:•.{$$'G..''T
L
L
Reviewer/Inspector Name " -� Phone: 19y0-1133 33D D
Reviewer/Inspector Signature: Date: z 2p
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
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
f2 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ELNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N 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
[RNo
❑ 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
;Z 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
n No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
S No
❑ NA
❑ NE
Additional Coiimentsund/nor,"Drawingstix 'MOW,Vk
Page 3 of 3 12128104
Page 3 of 3 12128104

i7 [�ivision of Water Quality 1,011-1 0_
Facility Number 0 Division of Soil and Water Conservation
Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
��ommpliance
e'Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: �� Arrival Time: : Departure Time: County: Region:
Farm Name: I%�,� _¢rrn _ _( 3 Owner Email:
Owner Name: c� ��`Gtn S �I� Phone:
Mailing Address:
Physical Address: r� J/1a-
Facility Contact: 00,g 7 IC z!`edS_ Title: Phone No:
Onsite Representative: S Integrator:
Certified Operator: r Ste_ Operator Certitic ion Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =' =' = Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ElLayer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Points
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy -Cow
❑ Dairy Calf
❑ Dairy Heitei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pail 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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes A No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
12128104 Continued

1
' Facility Number: — Date of Inspection
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,tgNo ❑ 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):
Freeboard Y #&o
Observed (in):
r7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
171 No ❑ NA [__1 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
thE21, notify DWQ
7. Do any of the structures need maintenance or improvement?
P] Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R 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
CK No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JXNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP`f
❑ Yes
[9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A AL
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection?
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP [I Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes X No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IM No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(,-7. No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
allo
❑ 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
4 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

.1�
Type of Visit ®'Compliance Inspection O Operation Review O 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:® ArrivalTime:
' (7 Departure Time: i df7 County:
OF
Farm Name: _,iZ/_;Ad_s Z er' 7-_a—,_2 r c ___ 1. _2 d- Owner Email:
Owner Name: n r+ i G �/'�(g�s _e— Phone:
Mailing Address:
Physical Address:
Facility Contact: i" Title: Phone No:
Onsite Representative: Integrator:el
_Cl2�rrd_
Certified Operator: 42n Z ____ _ U lJ�Lfrr� P1 Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Sack -up Certification Number:
Region:
=O =a = g =p =6 = u
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
CKNo
❑ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
29,No
❑ Yes
(QNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
12128104 Continued

Facility Number — Date of Inspection
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C&No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard?
❑ Yes
O No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: ' a�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Y2Z i 2: M
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CQ 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
21 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?
R Yes
❑ No [3NA ❑ N E
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9] 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
34 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1 r �� �. 'Z a 2
13. Soil type(s) /I/rll►�.�`a...
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z[No ❑ NA ElNE
�
15. Does the receiving crop and/or land application site need improvement? [:]Yes
R�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes
MNo
El NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
rw'RtNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
QlNo
❑ NA
❑ NE
u :r Guo�k t-.6%�r�cc o-�� 6�•� ks
67e,.^rne1�
Reviewer/Inspector Name _.. - ; Phone: !Y^`
Reviewer/Inspector Signature Date:--�rQO�v
12128104 Continued

TFacility Number: — Date of Inspection
-,Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ 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 El Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PQ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
4No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
.91 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[.No
❑ NA
❑ NE
26.
Did the facility tail to have an actively certified operator in charge?
❑ Yes
[g No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'KNo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
59 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
[9No
❑ 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
R No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
f q No
❑ NA
❑ NE
��' .. .vim MAW 4� k4 ^r . I i ` .
Additional Comments and/oriDrawin�y�s
a..� ��'�a.
a d 02O 0 (a 4 ad a d rof ; ,ti j-1- cr-, a-
F r s . Ga ll im 9014 your
s
12128104

Date o1• Visit: 9 Ol a Time:
Facility Number g �-
Not Onerational 0 Below Threshold7l
Permitted ©Certifie�d(//� 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
_ K 1 ----
Farm Name: ra s e- ✓ Fa e m s 1 , o�� 3 .- County: 5 d•+"+>�te r,
Owner Name: __A0 a r�* , G -_ 17 r 0. CQ a ��� Phone No: S n 7
Mailing Address: O 0 P�'n e- G f i vt.-k" ra/" i11 G 03 2.?
Facility Contact: Title:
Onsite Representative: w acQs
Certified Operator: n oil!+
Location of Farm:
Phone No:
Integrator: rn b�� - �''0i-j41
Operator Certification Number: $�
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 01 Liu Longitude 0' 0"
Design;$:
> Current ;`'<,a3 Q�` IDcsign :CurrentS;PE E E ' �tR E( <,3' E`Design';i >�EEC01 urrentr'`
Swine. ° Caacity
Po' ulationr"'�Poult 'Ca� �acitrJ;":Po ulatiotaittic' Ca' achy- 'Po' ulation'�'':�
❑ Wean to Feeder
❑ La er ❑ Dairy
Feeder to Finish 116
;. 10 Non -Layer ' E ❑ Non -Dairy
❑ Farrow to Wean
a-
❑Other �F<,,3
❑ Farrow to Feeder
;; .� �� �Ey ,';i�.�°� .,iE Er,3.��'�''�'
❑Farrow to Finish
I >, Total Degigm,Capadty!�„ i,,
Gilts
❑ Boars
r Total SSLW ;`
i L`
Number.of Lagoons
©i r ❑ Subsurface Drains Present ❑ La oon Area S rav Field Area,f
,--HoldingFonds L Solid
E, y', No Liquid Waste Mana ement 5 stem 1j
Discharges & 5tream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1� No
Waste CUlleCtign & TreatmMt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ` 3
Freeboard (inches): `� y✓ -3O ll
05103101 Continued

acili Number:
� a — //o+' Date of Inspection o/ o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ;4 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes JXI No
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 M No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ®,No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes CZ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes P9 No
❑ Excessive Ponnnding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type L�� rrn c. c¢a �3 r4 L �a� / sw+ e ! i' �r.�i ►-�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes El No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 91 No
b) Does the facility need a wettable acre determination? ❑ Yes W No
c) This facility is pended for a wettable acre determination? ❑ Yes ( No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes q No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [ j No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
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 M No
Air Quality representative immediately.
;e drawingsi a ilAdUtyttn'.better,explain ysituatio�ns �(use!additto3gm pages as aecessary)]: Field COPY ❑Final Notes
•',» ,.fir i7RP29 ygrlr 1.70i TMT r��Vff
(�i h -,A�­- wctS rlccJQ4 lQ- h \ 8ear1 Sarw. ��'t�.q LAsG S aippt <s jo
at S K a9 `v A w -4--, b r rt o>* a cl1­ c.s_ca+—
(Sro�c�
St+-j, ed+ prt T12 Q w ;L APor �7r{. { r: c.r%: 5oet c..t PrQ.>Au[..cr
L_' S'�cGG. 1
or LP,12-I 4U"T t"'�G1 ,Iasp� :p173 L1h.�r�aU) CbILLYa►J»F SAW, i�d.�4 '-
-C ZJ-k' 1rSpGC��l6►� LtvtA +\,c L 1�J� aLl +v '�4.�1'�ca-�c SL���G�[tGA� ,��p�,�Ur1~[
Joky' %
Reviewer/Inspector Name V.
Reviewer/Inspector Signature:
Date: T / D i / d
12112103 !/ Continued

Facii4y Number: v i y, Date of Inspection aI/
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes I] No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis [I Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�] No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[y� No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
M No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[N Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M1 No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
j No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

(Type of Visit (;Xomp' a Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 3 / o µ Time: o
r5 Not O perationall C Below Threshold
�ermitted t3rCerdfied © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: ....` }ifwS Gr......Fo_r.i"�.........,...........»................................................... County:......... Aw�pSO".................................................,
OwnerName:..... '�„t .....ADO'��nC r............................................ ................ -Phone No:........ g �o...ts���................................
Mailing Address: ..........3Qv....... .'..':w......Vivo..............J::..............NrlbinJL. Nc..........9.93oZ.S.........................................:.. ..........................
FacilityContact: ........................................................................»... Title:................................................................ Phone No:...................................................
Onsite Representative:..... �j?!?�?� t.......5rf....................................................... Integrator:...».�...... Farr., 5................,................
Certified Operator:.......... X 5.......f.?PIA �..................................................... Operator Certification Number:,.........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �"
Discharges' & Stream Impacts
1. Is any discharge observed from any part of the operation? es ElNo
Discharge originated at: ❑ Lagoon a 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 9<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ®'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifie�I/ r- ( go V
............................................................................................................................................................................................................
Freeboard (inches):
12112103 Continued

ft
Facility Number: //a Date of Inspection
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
[]Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) a-Y-'e s ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34., Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35, Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number: — Date of Inspection 63 3 n
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is ther vidence of over application? If yes, check the appropriate box below,
xcessive Ponding [:]PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
M Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Coi%nents' refer to r u�
w diiYaasre sisnd/ofan recammenatonsar a"i co:�Y1; .��"1ieston Exan
titEOn.aaB BSnEIIedaWlnKOf faCiLh0eeTieXiiao'(atry):
^ti
mll Co Final Notes
'VT
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Reviewer/Inspector Signature: Date: 03 03 O
12112103 Continued

Site Requires Immediate Attention: yG
Facility No. 07 _ a ? _
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time.
Farm Name/Owner: N V e
Mailing Address: ram- ze0i PP
County: ISQbmPito
Integrator: Phone: 4/0 31D -- 0 A V
On Site Representatif : IA&W Phone:
Physical Address/Location:
r
Type of Operation: Swine Poultry Cattle
Design Capacity: "'a Number of Animals on Site:
DEM Certification Number:. ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0 ',T"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) I@ No ua] Freeboard: 2 Ft. Inches
Was any seepage observed from the la oon(s)? Yes or o vas any erosion observed? Yes or No
Is adequate land available for spry ? eU No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facilitv meet SCS minimum setback criteria? 200 Feet from Dwellines? VesIr No
100 Feet from Wells?
Is the animal waste stockpiled within 100 Feet of USGS Blue.Line Stream? Yes or Uo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water oLAe state by man-made ditch, flushing system, or other
similar man-made devices? Yes orW If Yes, Please Explain.
Does the facility maintain adequate waste management r" (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:-------- ------ - - -- - - - - - - - - - - - — - - - -
"
Inspee(b'r
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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