820132_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: (y`Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: (D-lzoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: VU, Arrival Time: Departure Time: County: S O!) Region: ff_
Farm Name: ��" 1¢ n 6 P- r`a`dtvk-'SOwner Email:
Owner Name: 5a YVt p`�r J�a �,e- Phone:
Mailing Address:
Physical Address:
Facilitynn
Contact: C�
V w4 i `s
l� o�/'W L G Title:
Phone:
Onsite Representative:
t r
Integrator: _44(r7"
Certified Operator:
���1
ffo,4 - e
Certification Number: M 1
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
esi Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Finish
La er
Wean to Feeder
Non -La er
.ram
Design Cetrrent
D . 1'oultr Ca aci Po
La ers
DairyCalf
Feeder to Finish
7.D-
DairyHeifer
Farrow to Wean
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Gilts
Beef Stocker
Non -Layers
113eef Feeder
P.Boars
Pullets
Beef Brood Cow
Turke Poults
Other
ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes � ❑ NA [_]NE
❑ Yes
❑ No
[B-NA
❑ NE
❑ Yes
❑ No
ET AA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes
[::]No
NA
❑ NE
❑ Yes
2-T'To
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page l of 3 21412015 Continued

Facility Number: - Date of Ins ection: LAc c
Waste Collection & Treatment _
4rls 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 �❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c� 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QN6-_ ❑ 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 E31? o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? es E�< [DNA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [X>kr'❑ 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 ED-Na— ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes D No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] l"o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): • C rS r+ .f cSir 0
13. Soil Type(s): _ zzucl /A%p
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes is
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes <o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 4o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps [:]Lease Agreements
[] Yes
To
❑ NA
❑ NE
❑ Yes
E2rNo
❑ NA
❑ NE
[:]Yes
E j o
❑ NA
❑ NE
❑ Yes
❑,<o
NA
❑ NE
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [P "'o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SoiI 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 [rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes I ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Ins ection:
24. Did the facilityfail to calibrate waste application equipment as re required b the permit? Yes o NA NE
PPq Y P ❑ �❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []wo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes to ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EJ-Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EKo ❑ 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 L4,N6 ❑ 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
EJ.I o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3] No
❑ NA
❑ NE
Reviewer/Inspector Signature: c Date: s
Page 3 of 3 21412015

■ J VU UK r 151U `f LZ
[i ' ■"NPV .11uu j vperanun e�eview v MULIUiure r.vaiaaiwn v [ ecnmcai pubmstauce
Reason for Visit: utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 1 11 Arrival Time: t} Departure Time: 4 Ora County: :S !L Region: P71Z �
Farm Name: �01A-c- Ho Q C_ �G4f��' Owner Email:
Owner Name: S CU4A Ur Phone:
Mailing Address:
Physical Address:
Facility Contact:c.+t 5 j c1�1`tuL�C fit Title:
Onsite Representative: t r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 14� q` S.
Certification Number:
Certification Number:
Longitude:
Al
.,restgn Current= - , . Design Carrent� `
Design C+urrent
vvinap'ac�ty
mswine-..
-Wean
Pop Wet Poultry
Capacity4Pop
Cattle
Capacity Pop.
toFinish ,0 La er ��
Dai Cow
Wean to Feeder Non -Layer y,
Dai Calf
Feeder to Finish
a,�
,� �`x'
Dai Heifer
Farrow to Wean
0.
Desig" Currents k
D Cow
Farrow to Feeder
1D , P.oult s
Ca acety.Po Tom'
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts*
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turkeys
-A
Other
>>n
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
✓ NA
❑ NE
❑ Yes
❑ No
[FICA
❑ NE
❑ Yes
[] No
EfrNA
❑ NE
❑ Yes
[2'No
❑ NA
❑ NE
❑ Yes
[TNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facilitumb�er: �Z - 13 Zr Date of inspection. - i•yL
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
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
B-N—o—❑ NA ❑ NE
❑ No ©-17C ❑ NE
Structure 5 Structure 6
❑ Yes D-1510 ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[D 1"0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
[]'llo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F-4 sfo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E]"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): 9 r- 4"1M. (" 'I eL r"t fT (,,,- s 6
13. Soil Type(s): 0A11y
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes l�J"o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CjNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ to ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes B N ❑ NA ❑ NE
[:]Yes 2'1 o ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ef"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [i] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 [3 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

Facility Number: TT - 7.�? Z Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D-5o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EErfro ❑ 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
[A-16 ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
IJ 1 o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.- At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes g-iw ❑ 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 1 rJ 5o ❑ 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
[3<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ef No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Z'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).
�s�f��, s-ter z�c�
JK,Vf`��_
0,ye -e4o--) 0&
C Cf
Reviewer/Inspector Name: II V Phone: x, 03'3. 3
JI)
Reviewer/Inspector Signature: tADater
Page 3 of 3 21412015

F)
a ype of visit: ky.cumpuance inspection V uperanon Keview V zzirructure r vaivanon V i ecnmcai nssisiance
Reason for Visit: Q. butine O Complaint' O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: `p Arrival Time: . �O Departure Time: p ,1'� County:y�'[s
Farm Name: s'4-(q dg; FCC v-"-y Owner Email:
Owner Name: 'stz"t', KW W Phone:
Mailing Address:
Physical Address:
Facility Contact: [�� 1 .o- AJL`Gk Title:
Onsite Representative: K
Certified Operator: m f k
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region?7?0
Integrator: !'1
Certification Number: 7d + ,(
Certification Number:
Longitude: .
Design Current
Swine Capacity Pop. Wet Poultry
Design Current Desiga Current
Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
-- - Dairy Heifer
Design Current Dry Cow
Ca aci Po Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
S zp
�/
D : P,oul
Farrow to Finish
ILayers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 [P. d ❑ NA ❑ NE
❑ Yes
[—]No
[3,.NA
❑ NE
❑ Yes
❑ No
[2 NA
❑ NE
[—]Yes
[—]No
ffr�A
❑ NE
❑ Yes
[A -No
❑ NA
❑ NE
❑ Yes
Ea-17o
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili 'Number: - Z Date of Ins ection: go
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED-Nz--E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [3'gA— ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll r
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes [B <o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 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 C'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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [fNo ❑ NA ❑ NE
maintenance or improvement?
1 1. 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): T
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes 2<o [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z ppd'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []^No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [g-No ❑ NA ❑ NE
❑ Yes [3�qo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[20IRo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3'�lo
❑ 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
[DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[; No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
[�No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili umber: $A, - Date of Ins ection:
i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�o ❑ NA ❑ NE
•%
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®,Fto ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
�lo
❑ NA
❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes M"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ff No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ff No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ZNo ❑ NA ❑ NE
Comments -(refer toTgtiestion ft Explain any YES answers and/or any additional recommendations or any 'other comments:
. E.
Use drawings of facility to better explain situations [use additional.oaees as necessarvl.
Ca'Gb1V1_4C_0_n -
-?- ) - PY
tuAx- ` �r -3ocs
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
-u
0 , q.-� -P - �. 0
Phone: 0 .7 1 - 1 33 —S
Date: RU
2/412 J11

! ype of visit: &y7outine
ante inspection U Operation Review Q) Structure Evaluation V "Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rLqArrival Time: Departure Time: [ Zi County: Region:
Farm Name: rt/t'1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �f -A,ltt C Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 7
Certification Number:
Longitude:
Design Current . Design Current =
Design Current
Swine
Capactty =Pop. _. Wet Poultry Capactty > .Pogz=Cattle
Capacity Pop.
Wean to Finish
-`
Layer
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dl'I
" Design Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , $oul Ga act Pa
iry
Farrow to Finish
JLayers
Non-Laye
Beef Stocker
Beef Feeder
Gilts
Pullets
Boars
:_.
Beef Brood Cow
Turkeys
Other
'
Turkey Puults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
NNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
6<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
1Noo
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 C 21412011 Continued

Facility -Number: - Date of inspection: /'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z;4ffo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Cg-KA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
reat, 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
KN o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E
❑ 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): � r_4 0
13, Soil Type(s): 6 �. lAo" 4�
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
�o
❑ 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
Oo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[j3No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F_A`f�4o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 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 EI'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 [ZrNo ❑ 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

r
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EI-NT NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�3e<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes �� ❑ 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 []rl o ❑ NA ❑ NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes D-K'. ❑ NA ❑ NE
❑ Yes EKo ❑ NA ❑ NE
❑ Yes D No
[:]Yes ❑'I o
[—]Yes Callo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Date:— z 14 U L� _� &
l� r
Page 3 of 3 21412014

IriT -�j &r
Type of Visit: 40"7Routine
fiance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: ti 'Arrival Time: Departure Time: County, 'y ice.. RegioE/��
Farm Name:_ -SQ tM _ � V.rX-tJ Owner Email:
Owner Name: �[; �} (� Phone:
Mailing Address:
Physical Address: /1 Facility Contact: �� t �'� 1 j 4ate_-L Title: 77fC _ Phone:
Onsite Representative: Integrator: A / Certified Operator: SG t Certification Number: ( r7
0 q`/
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Ow�f -
esign„ Current } Des�gn�+� Carrent Design
A
Swine pacttyPop Wet Poultry - Capaci�l'op_., Cattle Capacity
ECC
Wean to Finish La er Da Cow
C►urreot
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
-
I INon-Layer I
Designer Cucrent�`
P..o
U , P■oul Ca ary
93
Dairy Calf
Dairy Heifer
D Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
Gilts
Layers
Beef Stocker
Beef Feeder
Non -Layers
Boars'
n
Pullets
Beef Brood Cow
Turkc s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 []�W ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [a>lo
❑ Yes ENo
Z] 1KA ❑ NE
[D,,NA ❑ NE
[ZNA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: P7-I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
'r
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[-pie---❑ NA ❑ NE
❑ No Q_NA-_❑ NE
Structure 6
,] Yes [ �❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
[D-No- ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E34'v- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�-t ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [.ad_— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurelStudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 1 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s): '6f ur loll v�fi� a S r [9 ,, <_ lj
13. Soil Type(s):
11
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes MNo
❑ Yes [ oo
❑ Yes
U94410-
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E&>id-'❑ NA
❑ Yes Q-No ❑ NA
❑ NE
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? []Yes [D o ❑ NA [] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QI s- ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes P ' - ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers _ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" 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 NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ection•
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes
J5. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
Q-K° ❑ NA ❑ NE
lam -Co ❑ NA ❑ NE
❑ Yes
Il.
❑ NA
❑ NE
[:]Yes
aW
❑ NA
❑ NE
❑ Yes
u g o
❑ NA
❑ NE
❑ Yes [Zk o` ❑ NA ❑ NE
❑ Yes [t�<o ❑ NA ❑ NE
❑ Yes LD-No— ❑ NA 0 NE
❑ Yes
No
❑ Yes
CJ-IGo
❑ Yes
[D'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: L
Page 3 of 3 21412011

s
Type of Visit: mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QR'outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: ; qnt Departure Time: ' r County: Region:
Farm Name: Owner Email:
Owner Name: C�[J� Phone:
Mailing Address:
Physical Address:
Facility Contact: �.u0.3.5%R�.,��Ci� Title: Phone:
Onsite Representative: Integrator: M> tRCJ6,L \ R cLo
Certified Operator: Certification Number: 1_1IaLkA
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
= Des�gnCurrent
Design Current - Design Current
Swine Capacity _; Pop.
Vet Poultry ..Capacity Pop, Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
p
_
Design Current_
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D ,ry Pooult , wa' ry Caci FPo .
ity
Farrow to Finish
La ers
Nan -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes [RTo ❑ NA ❑ NE
[:]Yes [:]No EgIfIA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ IKVA
❑ 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
[� o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[°NNo
❑ NA
[] NE
of the State other than from a discharge?
Page l of 21412011 Continued

[Facility Number: '3— - Date of inspection: ska I J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `iq
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
C No ❑ NA ❑ NE
❑ No GaMA ❑ NE
Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes [g"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 &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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [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 AcEg!2.ble Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): A, (Zy \ tT �� �_ , � (N V0 or)
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes &No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ENo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [v'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes [► 'No ❑ NA ❑ NE
❑ Yes E�(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 0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[-]Yes 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 dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes D No
D A
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: a, - ► Date of Inspection: S kj,3 IQ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ErNo
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 ErNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
i�cvmcwuiritibpc"wi imanau,
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA E3/ E
❑ Yes FV- No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes E f No ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes CE(No
❑ Yes [2"No
❑ Yes dNo
D NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
rA�ui�c. �1 tiy �.7vV- L90 7 �
Date: �--
2/4/2011

ivision of Wate Quality
Facility Number ®- /� Division of Soil and Water Conservation
Other Agency
IG
Type of Visit: ompliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: r,2,' Departure Time: /!� County: Region:
Farm Name: Owner Email:
Owner Name: p5:�cc Phone:
Mailing Address:
Physical Address:
�I�D
Facility Contact: at' cS p ," Title: QoL" Phone:
Onsite Representative: Integrator: JWr,6
Certified Operator: V Certification Number: 12E W
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts ��
1. Is any discharge observed from any part of the operation? ❑ Yes 03 -i1O ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[-]Yes
❑ No
�
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
LPL'
❑ 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
[E"1QA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ED-N-o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q-<o ❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facifi Number: - Date of Ins ection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [' 1�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:1
Spillway?:
Designed Freeboard (in): j
Observed Freeboard (in): �
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ugo<
❑ 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
[]"Na
❑ 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
Ej 1`io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Qo<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
© o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Er o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[0 No
❑ NA
❑ NE
❑ Excessive Ponding 0 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): " U j
14. Do the receiving crops differ from Jose designated in the CAWMP?
❑ Yes
E] o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Dolgo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Do o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:-9<0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FZ�K0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
3 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q.Pt_ ❑ 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 NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 A ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection: 71
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 52<o ❑ 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 E2- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA 93-1115
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes [!JeNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes gllo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes Q o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Rio ❑ NA ❑ NE
omments (refer toquestion f: Explain any YES answers and/or any additional recommendations.or anyother4comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�.P' &" it j"
1aC_jMh\_ -
Pliea S. o,,�ae-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
c C's I ,JeT tSaa ISVTA_
Phone: 33 3
Date: %Z f
412011

R Z-Af t -_7 _ n <— -:� ^ irn
Type of Visit (ITompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit @11outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date or Visit: Arrival Time: Departure Time: %Oi30 County. S� 50•✓ Region: If' -Op,
Farm Name: J�al� 'n .' Ps . 5 „ Owner Email:
Owner Name: .5-a jK4 /gyp --- Phone:
Mailing Address:
Physical Address: pp
Facility Contact: Gar YrI S E�4 Ka "� Title: 7"�.OG r--- Phone No:
Onsite Representative: Integrator: (fo Y h t
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ I ❑ " Longitude: ❑ ° ❑ I ❑ u
Design Current
Design Current
Design
C•nrrent
Swine Capty Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Da Calf
® Feeder to Finish 72577
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
El
Farrow to Finish
❑ La ers
LaEl
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poulls
❑
plumber of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B<o
❑ 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
R<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ENo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Z-132-
/-2- �o
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LP
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 l_7No ❑ NA ❑ NE
❑ Yes B o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ETNo ❑ 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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [! o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ElYes 2<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ffNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drifi ❑ Application Outside of Area 1
12. Crop type(s) 45---✓A. u -1 e— L �ta z c__ � 5"—a41 6,-, "-1 l p v e ✓S & Cd_J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E11 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L��,/No
[:1 NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detertrtination�❑
Yes
6d i�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2<.
❑ NA
❑ NE
Reviewer/Inspector Name -3' Phone:
Reviewer/Inspector Signature: /Q A( Date: / , Z $ `" Zy 1 a
1212VO4 Continued

f , T
Facility Number: Z —1 Z pate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q .to ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2I+10 ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ETNo ❑ 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 ❑l Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L���'N�o El NA -
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
No El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,Li
❑ NA
�_.g�,'
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1'N�o
NA
❑ NE
26.
Did the facilityfail to have an active! certified operator in charge?
Y P g
❑ Yes
,LI0
1 �No L1 NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&. 54o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP.
❑ Yes
14 ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
D 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
�/
lQ No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
12128✓04

-j w it, -o7-zooq
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation
- Q Other Agency
Type of Visit 0�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /iP - O 9 Arrival Time: /Q'QO Departure Time: /0; 2 County: Region:
Farm Name: s4 /Ll Yf.-S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: rw + Title: �c-C� s Phone No:
Onsite Representative: q Integrator: t r✓iLt rl�� FirWi--s
Certified Operator: wue f J - �°� t- Operator Certification Number: / 7ypk/ V
Back-up Operator:
Location of Farm:
Back-up Certification Number:
=O �, ED" g =o=r =,.
Latitude: Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 2-0 1 _?a 6,d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -Laud
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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 'P:,.opulation .
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy FIcifei
❑
Dry Cow
❑
Non -Dairy_
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
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 ❑-5'o ❑ NA ❑ NE
❑ Yes
❑ No
B-igA
❑ NE
❑ Yes
❑ No
E;-*A
❑ NE
210A
❑ NE
❑ Yes
❑ No
❑ Yes
B?1 -
❑ NA
❑ NE
❑ Yes
0'l o-
❑ NA
❑ NE
12128104 Continued

Facility Number: 62
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 S N/
El Yes Yes No
Structure 5
El NA [I NE
El NA ❑NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
i
Observed Freeboard (in): 3 to
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L7 tvo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [fNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes E i//Vo El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ffNo ❑ 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 ❑ E Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement?
11.
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Z3e*- ., JG.
13.
Soil type(s) jn D
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
o
❑ NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�L
E wo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
B<o
❑ NA ElNE
18.
Is there a lack of properly operating waste application equipment? El2 Yes
o
❑ NA ❑ NE
Comments {referto questtonw#) Explain aayTYES answersand/or any recommendationsor"anyot�er comments.
kUse dr�awmgs�nfjfacility t}o better 4xplaia sttuateaas.�(use sdd Eional pagesaecessar.}•) 4A�
L
ReviewerllnspectorName ck[, � yG%S Phone: 9/0, *33 .333
Reviewer/inspector Signature: T` ��.¢�� Date: 9-1�o-260
Page 2 of 3 12128104 Continued

LFacility Number: 82— —1? Date of Inspection
Required Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes _L_I NNoo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA [I NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[T No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V
Rain Inspectionss E]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B N/o
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElE Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
�3"No
ErNo
❑ 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
B<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
L'1No
ElNA
ElNE
ElB Yes
o
❑ NA
❑ NE
❑ Yes
B o
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104

f,1m S' 9- oq—d!2 ,er,--
-
Type of Visit compliance Inspection U Operation Review O Structure Evaluation () Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ; pD County: Region: `
Farm Name: f _ e Az r--- Owner Email:
Owner Name: �q„ � ti__ __ Phone:
Mailing Address:
Physical Address:
Facility Contact: Cct� 5' t�ar�✓i kZ_r' Title: le- S>�P c Phone No:
AF
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = { 0 u Longitude: E_—] ° [--] , = «
Swine
Design _Current; rk Design Current �„ _+T- Design Current
Can ty plop Iahon� WetsPoultry @xapaci ,Population CNattle Capaclty Population
❑ Layer ❑ Dai Cow
i
4110 Non -Layer ❑ Dairy Calf
35219 3YVZ Dairy Heifer
Dry* Poultry ❑ QTY Cow
❑ Non-DaiEy
Layers
�; El Beef Stocker
❑ Non -Layers
❑ Beef Feeder
vj El ❑Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other - .INumber of Structures:
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
El Farrow
❑ Gilts
❑ Boars
Other"`
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [ 1 No ❑ NA ❑ NE
❑ Yes
❑ No
t_I NA
❑ NE
❑ Yes
❑ No
[;,?qA
❑ NE
❑ NA
ElNE
❑ Yes
❑ Yes
,❑No
No
El NA
El NE
[IE Yes
,L
No
❑ NA
❑ NE
12128104 Continued

Facility Number: V2 — .32 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D<o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0io
❑ 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
B' o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[T<o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes - "No [INA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L�No El NA El 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 Aoolication
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
D<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) ale" ,5.'&<(// ( �! • iV O'5" )
_
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�,/
NNoo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
,L.,J]
L'No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA ElNE
[<o
17.
Does the facility lack adequate acreage for land application? ❑ Yes
L IVo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
2 o
❑ NA ❑ NE
Reviewer/Inspector Name u [� f _ _ Phone: �!!i OUY,
Reviewer/Inspector Signature: Date: ���/
Page 2 of 3 12128194 Continued

Facility Number: gZ -%3Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E tvo ❑ NA ❑ NE
the appropirate 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 I"
Rain Inspectionss 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E o
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[TN_
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
io
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
,E
ISNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
�
Co
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Pr
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
��
B o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
S<o ❑ NA
❑ NE
is an , or Drawings;
Addittonal,Commen„
Page 3 of 3 12128104
:l

® Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- O Other Agency
Type of Visit 0 Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Date.of Visit: Arrival Time: Departure Time: G jS County: L`r S_Ow Region:
Farm Name: SC�pKab i��_ t- V wl Owner Email:
Owner Name: S(kt,4 Hr-4,e Phone:
Mailing Address:
Physical Address:
Facility Contact: �� ✓ t ' l� Title: 66&4 /% v Phone No:
Onsite Representative: Integrator:
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
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: [= 0 0 6 0 Longitude: =° 0 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ 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 Popttla,fion
❑ Dairy Cow
❑ Daity Calf
❑ Dairy Heifej
❑ D Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
LY No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

,- ti
Facility Number: TZ-137 Date of Inspection /0-W`47
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[XNo
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Wo
❑ 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
P No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drifi ElApplication Outside of Area
//
12. Crop type(s) 9eK4K4 ac d9X, (Gt-K e— smul� cy/y i✓ l0 . S. _ -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[�4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[�l No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other.comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name t$ Phone: yA9, y jj,336 O
Reviewer/Inspector Signature: Date: IV--O/— ZOD 7
[G/GO/VY 40R[[/lueR

Facility Number: $Z — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes lNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes q No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1� 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
7No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
17No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[?No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P 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
P 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
�R No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: J�'03-Q!v Arrival Time: 4'jQ Departure Time: County: S4.,n Q1,,'
Farm Name: %%dam �'.e, S _ Owner Email:
Owner Name: 1100Q L'- Phone:
Mailing Address:
Physical Address:
Facility Contact: SG'Iu 140e C� Title:
Onsite Representative: 6- )r-3a vWr'ex �
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity .Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 32- 5-0+3 9 2 IV
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -,-
Phone No:
Integrator: 0 0 kd G
Operator Certification Number:
Back-up Certification Number:
Region: Y"1210
Latitude: 1=1 o 0 {, Longitude: ❑ ° = = u
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ 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 Curreef:;r';
Cattle Capacity '.EopulatiOil
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: �h
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 0 No ❑ NA ❑ NE
❑ Yes
(X No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: ?Z — /3 Z Date of Inspection FT 73 - e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA El NE
a. if yes, is waste level into the structural freeboard? ❑ Yes MNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9 �
Observed Freeboard (in): .31
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 M 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 [ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [Z 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
] I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 9eY1k.U016 /f c7s -z in/ e!O ve,
13. Soil type(s)
/
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
M No
El NA
❑NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`;❑
Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5 No
❑ NA
❑ NE
Reviewer/Inspector Name �%� -G IL f, Phone: (,y/4J %86 %S11"/
Reviewer/Inspector Signature: Date: S Q j -'20d 162
12128104 Continued

Facility Number: $Z —112 Date of Inspection OF O
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[gNo
❑ NA
❑ NE
El Yes
V]No
El NA
❑NE
❑ Yes
WNo
® NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
U0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes (P No ❑ NA ❑ NE
Addih"ic mmenti aedLor Drawings
12128104

,Ya H 12a
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: 3 // c Arrival Time: S aS Departure Time: County: Sd.je-sov Region: Fi�o
Farm Name: Owner Email:
Owner Name: 14 sec Phone:
Mailing Address: 3 .S o /'YJa .42a ss jo$C742 . ---" 40:r
Physical Address:
Facility Contact: .500- Title: �o Ph/one ,No:
Onsite Representative: t�i��fisri ,Fc_!LIntegrator:
Certified Operator: ,S m�� „�_ a PC Operator Certification Number: 17syy
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = e = d Longitude: = ° 1=1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
' ❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
1 3-7-S-5>
12299
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
Non-L.
Pullets
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 HeifeE
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Humber 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 J] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
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
Identifier:
Spillway?: _
Designed Freeboard (in): a20. q
Observed Freeboard (in): 3,5- "
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes X 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? 1; 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 El Yes ®No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drin ❑ Application Outside of Area
12. Crop type(s) Leery W 9k
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
W No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
FXI No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ 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
P No
❑ NA ❑ NE
r
Reviewer/Inspector Name ®ate ��� phone: _�l"_ y�� Ar' `/ R
Reviewer/Inspector Signature: Date: _ 3111
12128104 Continued

F%cility umber: — i32 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes jo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UO No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑ Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
$ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ 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
UO No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[Y] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
© No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Cornnnentsand/or Diawngs
-
a,- oA/
K 12 - a
G V. r C. CA W & wIrk
f16+ J c v c_ e x C
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12128104

(Type of Visit (7Gompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit QV'Aoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: +� Oµ Tune: : po
O Not O erational O Below Threshold
0 Permitted © Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
S1 - — �a�"' oun : - ... i
Farm Name: .......................---............--•----•--•—I��C
---•----------•-- t3'................_.............___ ....._..._._.......
Owner Name: ��"` v [ Phone No:
Mailing Address:.. _30 ..a1o45S..!�ti . �:ii'i� _�Ai. !.r?$ 3 g
LLLL,,,, . - ---
Facility Contact: ..W._.._-- .......!. 'c._-� . Title ow^r A Phone No:
OnsiteRepresentative: ....�rt fA(wi[.K integrator:...,,....C-0-wric................_..
Certified Operator:,,•-.,,....-_._.__,. Operator Certification Number.
Location of Farm:
&Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 1 44 Longitude • 4 "
Discharges & Stream Impacts
I - Is any discharge observed from any part of the operation? ❑ Yes IRNo
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 ENO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ so
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 2140
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................. ... ....... __. _W_ ............
Freeboard (inches):
12112103 Continued

Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 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 maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type _Ann., 0,1 f,'
13. Do the receiving crops differ with those desi aced in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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 E r+ro
❑ Yes [flo
❑ Yes L!rNo
❑ Yes eNo
❑ Yes j�No
❑ Yes &f4o
❑ Yes &f4o
❑ Yes [fNo
❑ Yes EeNo
❑ Yes [j %
❑ Yes [+f No
❑ Yes [ o
❑ Yes dNo
❑ Yes UJINo
❑ Yes S No
❑ Yes R No
❑ Yes [+ �0
;Cammeats {refer to queshuu #) Expiawn any YESaaswers and/or aay _recommendateons or..auy otlxer comments. -:"
:Use dia of Ito better sttuatioas. �e sddttzonal! as uaeuxs a
s fsemty _ F { » ry> [+Field Copy ❑ Final Notes
*'k) �d I U I
- JVj rator� s
-..
Reviewer/Inspector Name _
Reviewer/Inspector Signature: Date: 0
rzi12m_3
(_'nntinnod

Facijity Number: �j,� — �3� Date of Inspection < o
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 2rNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
dyes El No
❑ Yes [ff'&o
❑ Yes GrNo
❑ Yes 2Vo
❑ Yes 2 No
❑ Yes [2rNo
12112103

-rq
Site Requires Immediate Attention: --VO _
Facility No. - 02— i32
�r
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2A Lo 1995
Time: _ 18-1 L 4A4
Farm Name/Owner: n,
Mailing Address: dw _Aaz�e 7A
County:
Integrator: [', h.., Q . Phone:
On Site Representative: Phone:
Physical Address/L.ocation:p�, _
Type of Operation: Swine _� Poultry Cattle
Design Capacity: Za g-, Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: =ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ge or No A teal Freeboard: _Ft. Inches
Was any seepage observed from the lqe
n(s)? Yes or Was any erosion o rved? Yes or No
Is adequate land available for pray?or No Is the cover crop adequate? Y or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? %or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or IQ
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(S) If Yes, Please Explain.
Does the facility maintain adequate waste management recoAs (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? yMe or No
Additional Comments:
4t4"e- Qec,7
Inspector N
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

Site Requires Immediate Attention: ,V_
Facility No.
� q
Farm Name/Owner:
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: `�, I995 1-/ ` 860
Time: /
Mailing Address: - -
Integrator — - phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: 2sC-wd2 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Wor No Actual Freeboard:__ij__Ft. _Inches
Was any seepage observed from the lagoon(s)? Yes ore Was any erosion observed? Yes olo
Is adequate land available for spray? es r No Is the.cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? a or No
Is the animal waste stockpiled within 100 Feet of USGS Blue.Line Stream? Yes or ( 0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map BIue Line: Yes or
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or IJo 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)? kiyor No
Additional Comments:
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:_ _
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location: _
f
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: " Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

,.. arsz_:QX. W3LS= H3===T PLAN CSR';'�-2TC-IT=N Foil =4 OR ZXPA== l=DLOTS
p1&ALse ratu= the cc=vlaend =or= to tsa Di7isioa of $ate,=flr3aatal YA=agamsat at
the Ade—sas as the ravarsa Aida of tILLs fozm.
Nacre of fa.--m (Please print) : �01 ^+ .yd C_
Ad-_4:ess: P#-, ,3,:k DL0_3
i, 3o sy Phone No
County : ,5c
_� n.
.. .: �.
Falocation: Latitude and Longitude:Z J �O (reTsi=ed) . Also.
please attach a copy of a county road map wi4:1 location identified.I`ve of operation (swine, layer, da =:y, etc.): e-
_
Desiy capacity (nu=ber of ani-mals) 5-;z
Average size of operation- (12 monch. populacion. avg.) :_ �i?d —
Average acreage needed for land application of waste (awres) : 775
aaaxxaa:axzaaea:ararsaaaaaaaraaasaaraaxaiaaxaaaay3aa:sasaasaa�y=aasaa�e��aaaasaa
Tsc�=cal S, aeialist Ca�'^t3dicatiaa
As a cec!-zical smecialisc designated by the North Carolina Soil and Water
Consar-ration Commission pursuant to ISA NCAC 6i .0005, I cert_iy that the new or
expa..ded anginal waste management system as installed for the fa= named above
has azi aii'wlal waste management plan that meets the design, cons`.r-action.
operation and =ai.^.cenance standards and specificacions of the Divisior. off
Environmental Y-anage-.ent and the USDA -Soil Consecration Ser-rice and/or the Narch
Carolina Soil and Water Cons er`rar_ior. Corr=_-ssion pursuant tc 1_A NCAC 2u.0217 and
ISA NCAC 67 .0001-.0005. The follawirg e7leumeres and their co__esponaing C1-n'
critpwia-fsa:saee_n verified by me or other designated technical specialists and
are included in the plan as applicable: mini,*nt n separations (buffers) ; liners or
e<Tuivalant for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and mount of land for waste ur- lizatiorl (Or use of thir? pa-;ty) ; access
or Ownership of proper waste application e<Tj_jpment; sc::ecuie for timing of
apnlica_ions; application raters; Loading rates; and the co .trcl Of the discharge
Of pollutants from stor,-,later runoff events less severe than the 25-year, 24-:'loth
Naa.< of Tacbzics.l
Aft___atiar_:_ 4L
Address {�,ge:,cy} :,
(?lease Priztt) K .
s.is_.ac 0'?f?7_/0) 61, �. _ .,. .., Care:_ -(_-QV -
7e==zaaaaaysasa�yaaesasaaa:aa= araaaaxaaaa>•aaa3ax=:aa,aaaaaaisa��asaasax
C. mar/'tea :agog .'��ayaa�t
I (we) understand -the operation and maintenance procedures est3blis;.ed in the
appio-red a..n,i:ral waste ma-magerme_nt plan for the fa-*.m named accve and will i,.ylemenc
these procedures. I (we) know that any additional exsar_sion to the existing
desiy capacity of the waste treat=ent and storage sysze:n* or cor:st_,tction of new
facilities will require a new certification to be submitted to the Division of
tovi_ar�-ae.^.ter! rianagement before the new a _-orals are stocked. I (we) also
LLaderstar:d that there must be no discharge of ani-aal waste Lrc.s this system to
surface wacars of the state either through a =an—naa.de c=-reyance or thr-ough .
runoff from a scor.m event less severe than the 23-yeax, 24-hou star:. The
approved plan trill be filed at the fa_= and at the office of the local Soil and
Water Conservation District_
lla=a of =.and C�a= (Please Print) m Eiv % GT f/, ..
Signal'-= s Late- 3 --2.5f
Naga Of Fiaaagar, if di;ferent fro:z owner (Please print)
Surat :_e: Date:
Natn: A change in land ownership requires nocificacian or a _ew certification
(if the approved plan is c'-%anged) to be submitted to the Division of
Envirorrental Management within 60 days of a title transfer.
DES USE ONLY:ACi_i#
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