820183_INSPECTIONS_20171231

NUH I H LAHULINA
Department of EnAwHIMIMI Qui

V-t 9 19 l+V% l it'
Type of Visit: QKompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: alcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: _ La,� L -"ram Owner Email:
Owner Name: U-0 'V's ,e �uJOAs Phone:
Mailing Address:
Physical Address:
Region: ��
Facility Contact: �Ct,i,w t� S (���WZtC/Ct Title: Phone:
a
Onsite Representative: x i Integrator: Pr
Certified Operator: it
Certification Number: j 0g-�g7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
o Finish La er airy Caw
rFe
Current
Pop.
o Feeder
-Layer
Dai Calf
to Finish
% S o
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish.
Dry P,oultr, Ca acit P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (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 Q'715 ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes []No
[:]Yes ❑'Flo
[:]Yes C2-No
[:]Yes ZrNo
[?IX ❑ NE
EJI A ❑ NE
EJI�A ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

lFacility Number: jDate of Inspection:
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-NO ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No B' I�A ❑ 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
❑'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ <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
2]1�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2'<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): -ice &U d� ---
13. Soil Type(s): ']tile, C Jept
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eno
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes d�,40 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F!(No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 d, o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

li'acili Number: - $ Date of [ns ection:
24. Did the facility fail to calibrate. waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25Is the facility out of compliance with permit conditions related to sludge? If yes, check
E] Yes
� "o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
2-go
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Fe o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface 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/lnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q' o ❑ NA ❑ NE
❑ Yes [R*I�o ❑ NA [] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Q<o ❑ NA ❑ NE
[]Yes
ffNo
❑ NA
❑ NE
❑ Yes
E:rNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Comnten s; (refer o: q ues ) Explain any VES:.answeraiandlor anyaadditlonW recommendations or,any
wiother comments ti , on
Useidkanas of facility to. better. eXulain 'situations?(use''additional:,pages�nsl,necessarv.).
Reviewer/Inspector Name:
Reviewer/Inspector Signature: PIN
Page 3 of 3
Phone: t n _�
Date:
21412 15

Y -) l r- I
tvision of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency 7
Type of Visit: aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: D1koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ¢UO Departure Time: v r County: $ Region:
Farm Name: dL �� L� —� Owner Email:
Owner Name: T c�cU'!` �i�t% Phone:
Mailing Address:
Physical Address:
Facility Contact: i p-d`UtVl Title:
Onsite Representative: 1Y
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
U
Latitude:
Phone:
Integrator: 6es �tf
Certification Number: tE: 3 ( 7
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry CHnaeltV Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facllhy. Number: - Date of Ins ectiorr.— 1'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[i]'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
go-1Po
❑ 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
El -'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
Ejl�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F- 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
P'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E:INo ❑ 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): _ r9C� Le& -
13. Soil Type(s): NO IV&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainhreakers on irrigation equipment? [] Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes B o
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETo
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 Q o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F.419'0
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.
'Cl Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[]Yes [2rNo ❑ NA ❑ NE
❑ Yes [2-,i'Gb ❑ NA ❑ NE
❑ Yes . No ❑ NA ❑ NE
❑ Yes [2-1�o ❑ NA ❑ NE
[] Yes
[E 1Mo
❑ NA
❑ NE
❑ Yes
[],M
❑ NA
❑ NE
❑ Yes
E:�No
❑ NA
❑ NE
lComments (refer, to question #)" Explain any;YES answers and/or any additional rccomtnendations,or any otheKekkomments.p,
Use'draw"Ings o"f facility=to,beiter explain situations (use' additional pa'ges;as ne, essary)° . P, �l�.iN4:,
(,1
s(aile .,t
Reviewer/Inspector Name: +3 j kA
Reviewer/Inspector Signature:
Page 3 of 3
��- K3 3 -3 3 3
'IM _ I —
Phone: 60T —lo Y f
Dat
2 4/201 S

t9'Dlvision of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (a-enmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: S'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L1.[� Departure Time:-.� County:
Farm Name: y i L I Owner Email:
Owner Name: Ct. K f ,( Phone:
Mailing Address:
Physical Address:
Region:I
Facility Contact: f�c� S '13,,w( Title: Phone:
Onsite Representative: Integrator: Pryer-�Cg-.e
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er I I �d
rou
lets
Poults
Design Current
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [ZjX' ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
[:]Yes [:]No
[Dyes ❑'No
❑ Yes Vo
NA ❑ NE
NA ❑ NE
C3 NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

+ Facility Number: -AJ Date of Inspection:,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 23-Ne` ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No --NAS❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -7Lu 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 [7"N0 [] 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 E240 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P31No ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes La"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): ru'_ff
13. Soil Type(s): Ae) A).(-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r,;Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes rf;M0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ErNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
MXo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�'No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:No
❑ NA
❑ NE
the appropriate box.
❑ W1IP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ZeNo
❑ 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
JZ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[,—,J"No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facilik Number: jDate of Inspection: o-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z3Ab ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [.Ado ❑ 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.
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
P.No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
Rio
❑ NA
❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
❑ Yes efNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [.Z(No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [JrNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any.odditional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional uaees as necessarv).
COU(C u POL/4f n ✓L Z[ �l `�
1411� f5
Reviewer/Inspcctor Name:
e
Reviewer/inspector Signature:
Page 3 of 3
Phone: f /,
Date: r CJ
21412 14

ivision of Water Resources
Facility Number - 7n] 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (>Compliance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: e'Voutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; 0 Departure Time County:y l9'%� Region
Farm Name: �k `G vu. 4 ' to Own pEmaii:
Owner Name: "D �Elj-�``C Phone:
Mailing Address:
Physical Address:
Facility Contact: J %&!NdZ_ e Title:
Onsite Representative: C�
Certified Operator: %_
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: Pev-4
Certification Number: % ��
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
llets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes io ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No rR011A_ ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [E�<A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ 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 dNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

L
Facility !Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Q`No ❑ NA ❑ NE
❑ No E3-N7C— ❑ 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 Q'l 1� ❑ 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
L.j'K ' ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
I ^ lvo ❑ 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
ErNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t )
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CVWMP?
❑ Yes
[&-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ig"'o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N
[3 NA
[3 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ 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 Fl"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 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 25'No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: Date of inspection,
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E 10
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
@Ko
❑ 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
g'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
23 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes is ❑ NA ❑ NE
❑ Yes E]�No ❑ NA ❑ NE
❑ Yes E]'No ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes LJJ '"
❑ Yes
❑ Yes rNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or -any other comments.,
UwArawings of facillty to (use better explain situations additional pages as -necessary) ; ..
C'Zactl4itorl I I
Is ��t S-6411-01
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
is-z6 i�f
Phone:
Date:
21412011

f. rrR ,J (K5 of
(OAlivision of Water Quality
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
(Type of Visit: NQ Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time Departure Time: County:
Farm Name: f drv-0,0 Owner Email:
Owner Name: 6 Gt,U' L T fry, Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: eIV- VA I a (r [j L?L Title: Phone:
Onsite Representative: (� T T Integrator: '
Certified Operator: Certification Number: J y�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[TLayer
Non -Layer
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes [!f'jNo
[:]Yes allo
D< ❑ NE
[Z'NA ❑ NE
[3"NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

i j
lFacility. Number: JDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
E5-NZ ❑ NA ❑ NE
�vu ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [ergo ❑ 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 [ ,W ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Lam""" ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) a "`
9. Does any part of the waste management system other than the waste structures require ❑ Yes [31IG ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 0.*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 jj [] Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): r O't &f[( 56 d
13. Soil Type(s):
J
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 E3'wo—
❑ Yes6
❑ Yes [G]•Pt6
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [; j N f ❑ NA 0 NE
❑ Yes [],?tf ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L.f Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
[9-15'
❑ 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
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Ins ection: rM.AJ
LJ
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[24AJe-- ❑ NA
❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[ig,< ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
®-No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L41'{4O ❑ NA
❑ NE
Other issues t
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes Z�- 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 �o ❑ 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 [E-Ko" ❑ 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 0. 6 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes r7lIQo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑'NIF ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes ED-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).
C�.t'b ���
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

i
-. ivision of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation Sr 3
0 Other Agency
Type of Visit: (D-eo—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: CD Koutine 0 Com faint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — t?"/3 Arrival Time: Departure Time:�" County: Region: /==/�-o
Farm Name: G.t-�� ,�� ljrt�� / G / D Owner Email:
Owner Name: �ti t-y��; r'GI D _. Phone:
Mailing Address:
Physical Address:
Facility Contact: ! Llers Fe2 f� Title: t-G. Phone:
Onsite Representative: ,s'G-�� Integrator:%Py--
Certified Operator: Certification Number: /fr.�1iT
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry -Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑Yes IQNo ❑NA ❑NE
[:]Yes [:]No
[:]Yes [:]No
[:]Yes [:]No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
•, Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
a No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ylI
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R7 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
®. Yes
❑'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ERNo
❑ 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
M No
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window //❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _�i � :L'W_6 a
13. Soil Type(s):
14. Do the receiving crops differ from thoseKesignated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
[E No
❑ NA
❑ NE
D Yes R No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2INo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 21 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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?
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes CR No
[:]Yes ® No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility.to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: On
Date: If _07_f9C3
21412011

,t
Type of Visit: WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0116outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t d, I Arrival Time: Od />7 Departure Time: I , d r+') County: oSAT Region: /� D
Farm Name: �fl �'A�4 4 - 4 �A fZmS LL C L.- { A Owner Email:
Owner Name: - C �u t h Phone:
Mailing Address:
Physical Address:
Facility Contact: k-7CjS Title: Phone:
Onsite Representative: ay..gv, E'_ Integrator: Pik Lr, L4-4
Certified Operator: kT_4, Certification Number: M2A
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Cdpacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle C*apacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
00"1
t1U
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
i_
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [2'N" o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No []f NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
DNA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes 61)"o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continuer!

} R +
Facility Number: 'a - 3 Date of Inspection: q75 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Structure 1 Structure 2 Structure 3
Identifier: 3
Spillway?:
Designed Freeboard (in): R _ }
Observed Freeboard (in): 14417
❑ NA [] NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 0 No ❑ NA ❑ NE
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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
2.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):.LRM�
13. Soil Type(s): N 51 [?2 A)61 a J�>__ _
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [✓7 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[yNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[-" 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
[Er No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
C3No
0 NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[ XA
❑ NE
Page 2 of 3
21412011 Continued

i
Facil ity Number: Date of Inspection: 0311
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes Eno ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge`?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]D/No
❑ NA
❑ NE
❑ Yes
[gr'�o
❑ NA
❑ NE
❑ Yes
[]]/No
❑ NA
❑ NE
❑ Yes g No ❑ NA ❑ NE
[—]Yes
[V(No
❑ NA
❑ NE
❑ Yes
rt7"No
❑ NA
❑ NE
[:]Yes [yNo
❑ Yes UNo
❑ Yes [�j No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or.any other. comments.-,.
Use drawings of facility to better explainsituations (use additional pages as -necessary)
Reviewer/Inspector Name: �ot� p���QrN Phone: C(k0 . jg1A , U
Signature:
Reviewer/Ins ector Si p g Date: ��\a
Page 3 of 3 21412011

-6l m.5 4, /G OZ
ivision of Water Quality
Facility Number ®- ® O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit:]
Arrival Time:
Departure Time: County:
Region:
Farm Name:
40t
—
L_ Owner Email:
Owner Name:
�e�. `
Phone:
Mailing Address:
Physical Address:
Facility Contact: ta,_�{S L�GfWtLll , , Title: Phone:
Onsite Representative: 6ct y Integrator: pra:-61"av
Certified Operator: �pp-(� l Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Other
Pau Its
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes I!;,<* ❑ NA ❑ NE
❑ Yes
❑ No
[t <A
❑ NE
[:]Yes
[:]No
❑.PdA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No 71?47' ❑ NE
❑ Yes P o ❑ NA ❑ NE
[:]Yes �o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilit Number: -Z& Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
//
a o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
D,(4o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
2- llama
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
To
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[]Yes
[ ,<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[!TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q'1`10
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Fj�-<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2-190
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
�o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'1 Teo ❑ 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 Cg o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No FDlA ❑ NE
Page 2 of 3 21412011 Continued

►�
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [v" No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [g KA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes to ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 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 10 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes M l"o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2<o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).t
I 'q- f 2, w I �A_.� _� Li e �,
L
pr%v-r
4C'_1-3 Aai
t wti z-v
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone:
Date:
21412011

Type of Visit (D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Olo-utine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1'7,'_30Aw I Departure Time: :00 County: Region:
Farm Name: C—! o Owner Email:
Owner Name: A NNE I'-0.i r C I o+� Phone:
Mailing Address:
Physical Address:
Facility Contact: CtxV`k`S 'K`^"'��� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = ' [:] Longitude: = ° = { 0
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry C+apacity Population
Cattle C•ap� ity Population
❑ Wean to Finish
❑ Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
® Feeder to Finish fF I &&
❑ Dairy Heifer
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
9$D
pry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Dry Cow
❑ Non-DaiEj
❑ Beef Stacker
El Beef Feeder
10 Beef Brood Cow
Uther
❑ Turkey Poults
❑ Other
Other
Number of Structures: 3
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
,--,<
L7 NA
❑ 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
lA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D[ Ro
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
E No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i
Facility Number: —/ 83 Date of Inspection �-ZI -ZafO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ' 'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in): 30 4 2- 5-s-,
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
e<o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
L.:.1 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes
�lo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
, _,/
E� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
f
12. Crop type(s) ��vti., �.d��a.. C "t, , SW, .14 0 rd,i hi e6, C. ..J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ErNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N5o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0'No
❑ NA
❑ NE
,.�.s�ti ra� �1.1�d3;-i;?���Z�
Comments (refer to'question #); Explain any YESanswers and/or any�recammendations.or-any othcrcomments;a �x
Use drawing's of facility to better explain sltuations.'(use'additro'nal page_ s as necessary):
Reviewer/inspector Name _F�Zi_Z Phone: 91 V , YV, 336D
Reviewer/Inspector Signature: Date: / -Z/ Zb/V7
12128104 Continued

Facility Number; Date of Inspection-zl—zd�a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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
CI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9<
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Vo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B<o
❑ 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
2rNo
❑ 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
EK
❑ 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
2<o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L-f 110 ❑ NA
❑ NE
v -5.�,€
nAdditianalCommentsiandlar"Drawings;
12128104
12128104

3TTIKA,.S r o o d- Zoo 5
Division of Water Quality
Facility Number ��. Q Division of Soil and Water Conservation;
41
0 Other Agency
A.d
Type of Visit erfompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /O- Q Arrival Time: Departure Time: / ,� jta County: S'el%�
Farm Name: AwCam" l0 Owner Email:
Owner Name: 41yye- F��►rGe 44-__ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �'"fr~S iGy c�t�'c-1� Title: -S a'�-' Phone No:
OnsiteRepresentative: Integrator:— ApCL4__
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = I = Longitude: = ° 0 I = 11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes B<o ❑ NA ❑ NE
❑ Yes
❑ No
ErNA
❑ NE
❑ Yes
❑ No
[J'5A-
❑ NE
ff NA
❑ NE
❑ Yes
❑ No
❑ Yes
[--}. IC
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — f Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0<0 ❑ NA
❑ NE
Structurlo Structur(? Structur.00 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
No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No—❑ NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[' l o ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2<o�[,] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2<o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop rWindow ❑ Evidence of Wind Drift ❑ Application Outside of Area
eL:.�—.� [
12. Crop type(s) Arigf_I� ) SAC. ���.., (0 % s •)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EINo
❑ 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
[? o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
<oo
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,L.
L.tf'No
❑ NA
❑ NE
Camme`nts {refer to question 0) Explain, a.nny"Y4ES answers and/ar any recammendatians arany other comments.
��� Z
Use drawin s of4facill �to better,explain situations. (use uQUITLonal pages as necessary}:
cl�d�j
!
/
C 3 Zv ` 2cy
ector Name
Reviewer/lns Phone:
p ;'h-- 1--- - ��-i ;� � ��
Reviewer/Inspector Signature:
-t-�e�� Date: `�O -- Z� d7
Page 2 of 3 12128104 Continued

Facility Number: Z — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ello--❑ 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
Rio ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Dllo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R oo ❑ NA
❑ NE
.25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5rNo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
To ❑ 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
�To ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P415--❑ 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
❑Ncr—❑ 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
❑-<�❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElB Yes
�
o ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D4d6t NA
❑ NE
Comments and/or Drawings:
12128104

14
.S
y—o �e—08 R2
Type of Visit erCo—mpiiance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (loutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g / d Arrival Time: gSUS' Departure Time: ;pp County: SuMQ Dv—, Region: `
FarmName: Owner Email: '
Owner Name: ob+ ly' '4A- tYC%d t Phone:
Mailing Address:
Physical Address:
Facility Contact: ._ �tl v {74 tiayhli �% _ Title: T:�B-c-r //Phone No:
Onsite Representative: Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: ❑ c 0 1 0 f1 Longitude: =°❑ 4 0
Design Current DesignCurrent Design Current
Swine Capacity Population Wet Poultry Capacity;, Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
Non -La ers
Pullets
Turkeys
Turkey Poults
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?
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
, �101.
Elff Yes No ❑ NA ❑ NE
❑ Yes
❑ No
ZNA
❑ NE
❑ Yes
❑ No
DNA
❑ NE
E NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
El NE
El Yes
,'No
2No
❑ NA
❑ NE
12128104 Continued

Facility Number: Z.—/ ffj
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?
Structured? Structure(/ Structurqr Structure 4
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .37 52 o7,5
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 0 No
❑ Yes'No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes [r N ❑ NA ❑ NE
❑ Yes ZNo ❑ 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
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [(NNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) , _, "
9. Does any part of the waste management system other than the waste structures require ❑ Yes L 1'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement? dNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes ❑ 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) RerN`tda. 6&Z ,� Sisf���ru! AJ' Co,S .
13.
Soil type(s) 8 q S
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
,��,
NNo [I NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes Yes
,Ld,
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
12 No El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
Comments (refer to question #) ,YExplain any YES MAW, and/ar, any recommendations or any other comments.
�=dings f'fa�eilit3ta better$°explain tg ons. (u uddit onal pages as necessary):
Reviewer/inspector Name I RjC F � �/�,�5 ' Phone., '7/4o 1 .33; 33361
Reviewer/Inspector Signature: Date: 8—//—ZDd8
Page 2 of 3 12128104 Continued

Date of Inspection
Facility Number:
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
[:I/No
❑ NA
❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes,'check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
❑ Weather Code
Rain Inspections/
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
[I NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
VN
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNjo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IJ No
❑ NA
❑ NE
Other Issues
29. 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
CNo
❑ 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
,�
LI 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
d_�
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
El yes
7
El NA
❑ NE
Additional Comments and/or Drnwings::
Page 3 of 3 12128104

B.rAfS C v�,rsaC o„j !`—/7-07 9 oe_
0 Division of Water Quality a ;°
Facility Number gZ ! g3 0 Division of Soil and Water Conservation Rt'
0 Other Agency day'
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Time: /: Z Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: ) - 44 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ca.y-A'.i141111"E�10Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
a
Latitude:
Phone No:
Integrator: <:::a" -i C_ rrcS
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Finish
300
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Puults
❑ 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?
� Longitude: = o = 6 =
Design Current
Cattle Capacity Population_.,_
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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 M No ❑ NA ❑ NE
❑ Yes
[% No
❑ NA
[:]NE
❑ Yes
r0No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ERNo
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
p No
❑ NA
❑ NE
12128104 Continued

ti
Facility Number: Z—
Date of inspection /7-6 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5­7 7 I/O
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which arc not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes F No
❑ Yes ® No
Structure 5
El NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes ER No ❑ NA ❑ NE
❑ Yes �9 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 [&No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,2 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 Drill ❑ Application Outside of Area
12.
Crop type(s) 1 �e +'l!._ "! r I( tkk-) J Ski Z/ 6ya, N t�Dye vS C
13.
Soil type(s) AleA Ali
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
( No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
[A No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
10 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):
�Ie4A./ . c �- o At 14 f,a ^j 3
.�
Reviewer/Inspector Name P'1 cK Phone: T/0, fQ3, 3300
Reviewer/Inspector Signature: -. Date: 9—/3"Zpd
12128104 Continued

Facility Number: SZ — /9-3 Date of Inspection 3 -d
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 [I Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 121 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? El Yes [ti No ❑ NA ❑ NE
23.' If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EO 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
X 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
M 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
VNo
❑ 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[Z No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water � uality
Facility Number Z 3 Division of Soil and Watcr Conservation
Q Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: —2s f7(o Arrival Time: %3S Departure Time: County: _4.N 5dn/
Farm Name: I C) Owner Email:
Owner Name: --—_—b_._1M ,; ,�eWc..� _—�--- --_ Phone:
Mailing Address:
Physical Address:
Region: 2Fka
Facility Contact: Cu kc6� , WLi t� �_ Title: Phone No:
Onsite Representative: Integrator: C p (elr��_rk-�'5 6 irw+
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = Q = I = I[ Longitude: = o = 6 =
fid
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
®
Farrow to Finish
Q
Z D
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Pouits
❑ 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
❑
Dair Calf
❑
Dairy Heifer
E3Dry
Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b, Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
CYNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
CXNo
❑ Yes
EgNo
❑ NA
❑ NE
❑ Yes
'No
LA
❑ NA
❑ NE
12128104 Continued

't .
Facility Number: gZ— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure Iv Structure® ' Structured Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): Iq / I 53 Of..
6,0 y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
t3No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[3No
❑ 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
159 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Q4 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
U No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[3No
❑ 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 Drifi ❑ Application Outside of Area
12. Crop type(s) 13 c.r ►v...k d c` 14o•.t s t", (( 6 vra
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ 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
[V No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
p :..
Revlewerlins ector Name i,c. e:V'Z Phone:
Reviewer/Inspector Signature: Date: �{—Z$— Zoo (R
12128104 Continued

.4
Facility Number: $2.—/S3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5§No ❑ NA ❑ NE
the appropirate box. ❑ WUp 0 Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X 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
KNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
�K NA
❑ NE
❑ Yes
❑ No
[XNA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
❑ No
29 NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
[50No
❑ NA
❑ NE
❑ Yes
C9 No
❑ NA
❑ NE.
❑ Yes
N No
❑ NA
❑ NE
❑ Yes [j No ❑ NA ❑ NE
Ailditinnal Cnrn nta and/or'Draws in '
12128104

Type of Visit 40 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: a lJ-r Arrival Time: J % 4 Departure Time: County: SGw.�cWoRegion:
Farm Name: Owner Email:
Owner Name: _ ® %� �� �°�"� Phone:
f
Mailing Address: y w�� o � �.ir fZaQ.
Physical Address: r f f. 0ems
Facility Contact: Title; Phone No:
Onsite Representative: Cu -4.0 ct, Integrator:
4s �-' �r �-� Operator Certification Number: b -J V7
Certified Operator: �__ ._s �__ __ _ p
Back-up Operator:
Location of Farm:
Swine
Sack -up Certification Number:
❑ O = 1 = {I g = O = i = 1{
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
.1
® Farrow to Finish
3 ao
O
© Gilts
S
© Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NI?
12128104 Continued

sl ±
Facility Number: ya — 1.03 Date of Inspection s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A 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 10 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 X 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
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CO 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
(9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
[I NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;U No
❑ NA
❑ NE
Aaditional Comments and/or Drawings:
12128104

f
Facility Number: lea Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C$] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): �;?�"
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 3 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�M No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[;1 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% 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) S p s
13. Soil type(s) /Yys 4o Ik- "I k o 911 _
14. Do the receiving crops differ From those designated in the CAWMP?
❑ Yes
UPNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El 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
UE No
❑ NA ❑ NE
7- A%wrsc,-7 Aou.ic, fau ll p� - is
4cc0, 0W'rn9 i r. fid�cwa/�S. 7-A,eve/6,, a�Pc r fo Gon,
f' G 14 9 Oo /. j f^fi. u C; r �c­r G , r e-, r 4 aL S , VV_,,X" C - t-A C0 n'fro l
Reviewer/Inspector Name �� T „ ;�-ry,4''� Phone:
Reviewer/inspector Signature: Date: ,16
12128104 Continued

Facility Number \ Date of Visit: b Imc: =
0 Not Operational 0 Below Threshold
❑ Permitted © Certified © Conditionally rtifie 0 Registered Date Last Operated or bove Threshold: .........................
0 i� Q.ij► C /O County: rSo
Farm Name: ........".:.:................r................
....... .................................................... ... ty:.................. .. .......... �........................ ..................
OwnerName:........�Ofi�•!C....~"` S............................................................ Phone No: ............ ...��.�.... ���i..�....................................
Mailing Address: .....,i..00.........................
rr........... a :......:........................ ....... Nr..........................2.s3.g.... ........................
Facility Contact: ... ..-15 ..... ' �t,J.......................... Title:........ . !124.0 ...................Phone No:...................................................
OnsiteRepresentative:.... r.✓' e ...... r w i............................................ Integrator:...... �46.!^f.'......................................................
Certified Operator:........... �`.r..'D�......p!".w :.................................................. Operator Certification Number:..........................................
Location of Farm:
twine ❑ Poultry ❑ Cattle ❑ Horse
i�f,f�EI
DestgnE CurrG
Latitude ' " Longitude ' "
!
'aci
nL
.
`Points , IE :�,• I.:E , „(, E
Cz} ;�Ra'lulat,on€
�'I ry,.Jl_,.`'..'.Ca aci ,11Po ulada
❑ WeanitoEFeedler
�'i
F ,k
❑ Layer
❑ Feeder to Finish
a".
❑ Non -Layer
❑ Farrow t0 Wean
I�i�#°;ar
❑Other
ow to Feeder
♦o
♦D
❑ Farrow to Finish
{
(' I lr fl ei��hl` ` " 1l ` {t ' `"� TotalDeSi)
❑ Gilts
1 Fliif E Bi
1
the '` ° �``�'
Dairy
Nan -Dairy
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:................................................................................... ......................
Freeboard (inches): 40 3 __q
12112103
'Population
iY��
i
�wwww �
❑ Yes
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[_-]Yes B-M^
❑ Yes S4qtr
❑ Yes @hNa
Structure 5
Continued

Facility Number:. g�
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?
B. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ut, _ 4.%11 4ek.i"
13. Do the receiving crops differ with thoddesignated 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 I%sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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.
lAv. &% 4 4 ki hod d4ee.
Reviewer/Inspector Name " ijj
Reviewer/Inspector Signature:
Date:
❑ Yes ffNo
❑ Yes U.Nc--
❑ Yes Biq5--
❑ Yes [,jNcr,
❑ Yes [}IC"—
❑ Yes 01�fo
❑ Yes DIKo
❑ Yes
❑ Yes ❑ No
❑ Yes Le1Q
❑ Yes
❑ Yes to
❑ Yes ;0
❑ Yes [}NT,
❑ Yes E+NT-'
❑ Yes
❑ Yes
Final Notes'
e
12112103 / l Continued

Facility Number: ? — Date of Inspection : B
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 3-K'5__
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes [� oo
E
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tvo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Leo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
L
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑New
28.
Does facility require a follow-up visit by same agency?
❑ Yes
m4 tl•
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�<O�
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
G-N —
3I .
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

Site Requires Immediate Attention:
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: / 0: 0
Farm Name/Owner:�o
Mailing Address:
County:_
Integrator: _ T
On Site Representative: —
Physical Address/Location:
0 w-e"
e
C%'d
G 'Z8 3 z S
Phone:_ yroA -sZZ- 3s,7-3 _
_ Phone:
b ak 4-a fi._e., sR 125, o
Type of Operation: Swine Poultry w Cattle
Design Capacity: 320 Soar 4e o to Nlu ber of Animals on Site: za0o a v` .st4t- (yxr'A 64•S .
DEM Certification Number: ACE �`_`s' DEM Certification Number: ACNEW
Latitude: Longitude: ° _' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot t 225 year k4 hour storm event
(approximately 1 Foot + 7 inches) (19 or No Actual Freeboard: 00CFt"3inches
Was any seepage observed from the lagoon(s)? Yes oi(3b Was any erosion observed? Yes oao
Is adequate land available for spray? es r No Is the cover crop adequate? or Lo
Crop(s) being utilized: AC w,vkit,.
Does the facility meet SCS ,minimum setback criteria? 200 Feet fr Dwellings? <rsk or No
100 Feet from Wells? it No
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 ord
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or & If Yes, Please Explain.
Does the facility maintain adequate waste management rewd (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop Y No or
Additional Comments: iT-&rn �.jork '4 t• W � '��'f�e
s ,
- - -,-, lL��+tL?�lT•T� - '
"�"/ ,
Inspector Narti
_"4 (;�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

t
1P
lilt �'
cr
ter_
'•. lift 1I�.L
!!4! 1`.
��
r �
r`�
.a 1tPt
r r y7?4 1234 chapel
!�P
1 !DL
e
/ IUL
or M
/ HnMNr
y9 ►ogler Im
�
6
1 �r Grn"
lUi
1LC1
q
173]- in N
1.6
fl.
g,
lisp
Herpraw
Her
l»� Im
S'Ix
{v10
9
a.t
Szli
'
IA
t1l1 ]Ill � H,duUu,
�
i1� lid ]i!1
4 a
{
y
l717.
i till 10 a
Sill
' lilt n 1 KwrrUA
4i ,
s,
.!
,r pJ ld
im
y vir lni
" mi
n4 VA
,
it 11f1!
Ell,
6
S� �.nr a lai
v
P42
.� lli7 u .tl3Y p -
�,1 Uu 7
... flak liR
mu LM
llii t 1� /.a
un
ti
I'
1 •! •ii � 4 '� � V
^ML
lllt
111i 7
]iil {? 1u5 lilt
llii. i 1� ,f
Isard�
p mil.! � tiw 1ii7�
t.�ti - L•
ti li>Z
lilt
D
U
A
�
N
p 1l➢1
4)
14
9
h
4h
a^
lx11
!Uf
lT9t ;
1Q11 t
..
!d
Im
I
RAW
Jim
A
ltt5
V+
t
1lSi
!�
191i
y
1.1 ltll
�
st„t v
am ,? }
ltu
V
ry
•n
1111
r
im
1P 1y
mg-
It
on
Im
Liu
�
Bit �� ;
r
.f
1Si1 d in
1w
'?j� 1f31
"'P
-do
}
1Ci5
�
'�
to
L
N tM1
Sfil 1�
t,5
lilt
—,.NTON
POP. ..saa yea
Kiey ltldW
Sii! S�
1 V iI.-. z ?a —
t► ir, li7 11ii
. JIUL r` y
1i71 1� v
Cagerd !
S!. y '�` Mt. � s• 'o p1i
Im J20
13� l� 1i7i llli +s
I.f
17lS h liYl v a �+
} ltli lid 119 1
l w L Lumn
uo ' �
n
11III 1
1•1
11Yt ' Hk
3.2
,•! —I U*071
11l! 11J1. y r.
FMJ
im
1w I

Site Requires Immediate Attention:./d
Facility No. _ ey _ 1�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:, z , 1995
Time: ' 4
Farm Name/Owner: !L f c1a t-47 + Q W e,v
Mailing Address: Po Bey 6�!(Q ^
County: 5a_haw'►
Integrator. d o Phone:
On Site Representative: L,, t, r7110 ,ale- Phc
Physical AddresskLQcaoon. &'-*ar at=An-
_- ..�..��.-ram
VQ_
Type of Operation: Swine Runtr
lCattle
Design Capacity: 300 'dw+r of Animals on Site: 2000 o," s. per amt aw .die...
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h sufficient freeboard of 1 Foot �+� 2Vnz524 hourstorm event
(approximately 1 Foot + 7 inches) erNo tual Freeboard�•:Inches
Was any seepage observed from the la n(s)? Yes oras any erosion observed? Yes, oKD
Is adequate land available for spray? gem No Is the cove cro adequate? or o
Crop(s) being utilized: Pew
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwe11' s? fte or No
100 Feet from Wells? 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 ine: Yes or
Is animal waste discharged into water of tke state by man-made ditch, flushing system, or other
similar man-made devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? e r No
Additional .Comments:� _ 0 A~4 .La c.+A4,4 i Af.1
L f.
Signatur
cc: Facility Assessment Unit Use Attachments if Needed.

jai

I - . & -, I �