820189_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: UCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: t^rx�outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - / Arrival Time: !>, j a Departure Time: �County: Region:
100,
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�Y7-r/'�/'%Dy/�z Title:
Phone:
Onsite Representative: ,�� Integrator:
Certified Operator: _ �� f�-LlG� G��.� Certification Number:gp2�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
tllebigu Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
iry Calf
Feeder to Finish
D
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P,ouItr,
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
?I
ITurkeyPouets
Other
Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [�Ko ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
Q-lgo
❑ NA
❑ NE,
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
NA
0 NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facili!X Number: / I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
eNo
[] NA
F] N E
a. If yes, is waste level into the structural freeboard?
[]Yes
0 No
[3 NA
C] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway9,
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[3 Yes
Ej"'Ko
E] 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
Ej1N_o
E] NA
C] 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?
r9-Y'es
[:]No
E] NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
[3-No
E] NA
E] 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
CDI�o
F] NA
F] NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
E:] Yes
No
[:] NA
[:] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [D Yes [3<o [:] NA [—] NE
F� Excessive Ponding E] Hydraulic Overload [] Frozen Ground [:] Heavy Metals (Cu, Zn, etc.)
M PAN M PAN> 10% or 10 lbs. E] Total Phosphorus [:] Failure to incorporate Manure/Sludge into Bare Soil
F-1 Outside of Acceptable Crop Window E3 Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): . �72Z22n84 Ay
13. Soil Type(s): / I-J19 -7f �_
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
E5-N-o
NA
E3NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
EfrNo
NA
NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
�o
[3 NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
EEr<o
n NA
n 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?
E] Yes
EY—No
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
�o
E] NA
NE
the appropriate box.
E1WUP E]Checklists [—] Design [:] Maps [:] Lease Agreements Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes FT�No
[I Waste Application [] Weekly Freeboard El Waste Analysis [] Soil Analysis Waste Transfers
E] Rainfall E] Stocking E] Crop Yield [] 120 Minute Inspections El Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? Yes EJ'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes
NA E] NE
Weather Code
Sludge Survey
F-1 NA F-1 NE
E] NA [D NE
Pag� 2 of 3
21412015 Continued

FFaellity Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [2-<o 0 NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes []�< 0 NA 0 NE
the appropriate box(es) below.
F� 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
ED Application Field 71 Lagoon/Storage Pond 7 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?
0 Yes
[3-<o
[DNA
E] NE
0 Yes
[][N'o
0 NA
0 NE
Yes
�o
[DNA
ONE
E] Yes El -No [:] NA [:] NE
0 Yes []r`N`�o 0 NA ONE
0 Yes E]<o 0 NA ONE
Yes El-N-o
Yes �o
Yes E-N-0
NA NE
NA NE
NA NE
Comments (refer to,qu6tion #):Eiplalif ahy:YES' answers andlor any additional:'i6�oinme'ndations-or, any other coinmenti.�.'.�.
9:7.
es�'ai-neceiilsarv)-'
Vs'e'�draiwings offacility.to better eiolainlsltuatio'ns' (use additional Flag,
74-0 To--,-
&/vw Z-
7
Revi ewer/[ nspector Name:
Reviewer/inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

� ivi"sign of Water Resources
ti
Facility Number f �p a Division of Soil and Water @anservation
� Other Agency
Type of Visit: ompliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / 1 71 Arrival Time: Departure Time: ' 3 O County: Region:
Farm Name: {r r}- 23
Owner Name:gi��
Mailing Address:
Physical Address:
Facility Contact: /7%,0 ar e- Title:
Owner Email:
Phone:
Phone:
Onsite Representative: jar Integrator:
Certified Operator: C o "*113 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pap,
Wet Paultry
Capacity
Pap.
Cattie Capaclty Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
i Calf
eeder to Finish
iry Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , I;oult
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Its
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Puults
Other
I
F16ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
SLNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
JN No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

IFacility Number: Date of Inspection: 97,11L—_I�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
Ea -No
0 NA
ONE
a. If yes, is waste level into the structural freeboard?
0 Yes
0 No
0 N A
0 N I,
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /2--
Observed Freeboard (in): �'l
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
rQ1 No
U01
0 NA
E] 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
E] Yes
IM No
J04
[:] 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?
(Zyes
E:] No
E] NA
[:] NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
FA No
0 NA
0 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
0 Yes
Q N o
LCK
0 NA
0 NE
maintenance or improvement?
Waste Ap lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
JR No
0 NA
ONE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. OYes rX No 0 NA 0 NE
" 'rN
0 Excessive Ponding Hydraulic Overload [] Frozen Cround Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10%or l0lbs. 0 Total Phosphorus Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift E] Ap'plication Outside of Approved Area
12. Crop Type(s): 5—r-r-M. 41� - / 9 C, _Iw In n1__j
13. Soil Type(s): IVA 7) / '�J t) t"'f -
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes 4No 0 NA ONE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ZR No E] NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes _2LNo [:] NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
[:] Yes [3 No NA [:] NE
[j Yes 2 No NA 0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes [;a No NA [3 NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check Yes [RNo NA E] NE
the appropriate box.
OWUP ElChecklists ODesign 0 Maps E] Lease Agreements 0 Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes E No
El Waste Application 0 Weekly Freeboard 0 Waste Analysis Ej Soil Analysis E] Waste Transfers
FjRainfall OStockingE1 Crop Yield E3120 Minute Inspections El Monthly and I" Rainfall Inspections
22, bid 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?
Yes ELNo
Yes FQ No
V_%�
NA [:] NE
Weather Code
Sludge Survey
NA NE
NA NE
Page 2 of 3 21412015 Continued

JlFacillty Number: e�� - / TT ��] jDateof Inspection: �L-Iq-J?
24, Did the facility fail to calibrate waste application equipment as required by the permit? Yes C2kNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes No
the appropriate box(es) below.
Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No
Otherlssues
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 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Application Field El Lagoon/Storage Pond M Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerl] nspector 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
F] Yes S No [:] NA [] NE
F] Yes [a No 0 NA [D NE
F] Yes [Z No F] NA [] N E
F] Yes [Z No [:] NA [] NE
Yes
No
NA
NE
Yes
No
NA
NE
[]Yes
allo
[DNA
NE
Comments (refer to question ft Explain,an.y YES:'answers and/or any additional recommendations or any other comments.,.
Use drawings of facility to better exiflain situaitionsluse additional pages as nceessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]f5_1
Date: �1­1,elP_ / ;;,
21412015

9 on es Urc
EACH um e L Z'75 1 Ision 0 UIIN-n-dkWa—te—rlCaonser�vatlon
I t e On c
ype of Visit: qK-Ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a-go"u—tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I Jt9; Z)E] DepartureTime: &Zy
_D lCounty: ���'�Region:
Form Name: Owner Email:
Owner Name: v e-, Phone:
r
Mailing Address:
PhyffirNFAddresr. Ctr he-�
Facility Contact: Title:
Onsite Representative:
Certified Operator:
�� t Phone:
Integrator: 01�/2z�®rl.5r_�
00,
Certification Number:' 9-09.-;Zo
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
esign
u ent
UT t
NoMesign en
e
a ael
a p woio
Wean to Finish
ayer
Dairy Cow
Wean to Feeder
on-LaXer
Dai[y Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
gn
Dry Cow
,Farrow to Feeder
It
Hpacl-
Non -Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
ITurkey Poults
er
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at-, D Structure Application Field E) 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?
[D Yes IK No [:] NA [:] NE
E] Yes E] No [DNA D NE
DYes DNo DNA DNE
[:]Yes [:]No
Yes rOl No
6chk
Yes JRNo
NA NE
NA NE
NA D NE
Page I of 3 21412015 Continued

lFacility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
0 No
D NA
D NE
a. If yes, is waste level into the structural freeboard?
Yes
D No
n NA
D NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
D Yes
�ZLNo
D NA
D NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
D Yes
�Z_No
[:] NA
D 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?
D Yes
gNo
D NA
D NE
8. Do any of the structures lack adequate markers as required by the pen -nit?
n Yes
allo
[:] NA
[3 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
r711 No
VZt-
DNA
D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
EZ No
0 NA
D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. E] Yes F ' O-No D NA F1 NE
Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
PAN M PAN> 10% or 10 lbs. Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): X� oc014t_ /V C�
13. Soil Type(s): AJ,0-',F Z Mal Z AZjLL
14. Do the receiving crops differ from those designated in the CAWMP? Yes f&No D NA [:] NE
15. Does the receiving crop and/or land application site need improvement? D Yes (2,No [DNA D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes [��,No D NA D NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
0 Yes [R No D NA D NE
Yes 1`�71 No D NA F
Ldzil _] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes allo [] NA D NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check D Yes 0,No D NA D NE
the appropriate box.
DWUP MChecklists D Design D Maps D Lease Agreements DOther:
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes 0,No
El Waste Application D Weekly Freeboard D Waste Analysis M Soil Analysis [-] Waste Transfers
D Rainfall DStocking D Crop Yield [] 120 Minute Inspections D Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? D Yes [�� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes IN No
D NA [] NE
D Weather Code
D Sludge Survey
D NA D NE
D NA [:] NE
Page 2 of 3 21412015 Continued

lFacillty Number: jjt�l­ ::] FD—ateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ffNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes P No
the appropriate box(es) below.
Failure to complete annual sludge survey E] 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? E] Yes E�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? M Yes CE�No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
F-1 Application Field 0 Lagoon/Storage Pond F� 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?
llwR
NA NE
NA NE
NA NE
NA N E
E] Yes [Z�No E] NA [] NE
E] Yes M No F] NA E] NE
E] Yes K No F] NA [3 NE
E] Yes P No C] NA [:] NE
[:] Yes jK No [:] NA NE
C] Yes a No C] NA NE
Yes rR No C] NA NE
pwe-7 7/r/ Tb /-7
L-)Lk_ L1,4-e
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 22��Y�_r__3`176
Date;
21412015

40�lvlslon of Water Resources
Facility Number Elial - F2FT 0 Division of Soil and Water Conservation
0 Other Agency
rype of Visit: (3mompl ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �Volutine 0 Complaint 0 Follow-uE 0 Referral 0 Emergency C) Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County
Farm Name: Owner Email:
Of
Owner Name: Aa�= Phone:
'077-
f Jr
Mailing Address:
Physical Address:
Facility Contact: Mopee Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
#_� I Phone:
Integrator:
Certification Number:
Certification Number:
Latitude; Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
34 Teeder to Finish
Farrow to Wean
Warrow to FecdCT
Farrow to inish
Gilts
Boars
Other
Other
ayer
Non-LaXer
Dry roultrX
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharizes and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: [] Structure El Application Field Other:
a. Was the conveyance man-made?
Region: APKD
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Daig Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
M Yes 0,No [:] NA [-] NE
[:] Yes E] No E] NA [:] NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[-]No
NA
E] 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)
E] Yes
E3No
NA
E] NE
2, Is there evidence of a past discharge from any part of the operation?
Yes
aN o
C] NA
[D NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
E] Yes
Q3,No
[:] NA
[D NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

lFacility Number: 6P2-;7- Date of Inspection: g'-10-1-4—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
CgNo
D NA
D NE
a. If yes, is waste level into the structural freeboard?
D Yes
D No
D NA
D 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?
D Yes
P!�No
D NA
D 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
D Yes
CE�No
D NA
D 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?
0 Yes
[:] No
[:] NA
[:] NE
8. Do any of the structures lack adequate markers as required by the permit?
DYes
ESNo
DNA
MNE
(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
D Yes
C&No
DNA
ONE
maintenance or improvement?
Waste Aimlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
D Yes
2jNo
D NA
0 NE
maintenance or improvement?
I I - Is there evidence of incorrect land application? If yes, check the appropriate box below, D Yes [B�No D NA D NE
Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
PAN M PAN > 10% or 10 lbs. Total Phosphorus D Failure to ITICOTPOTOIC ManUTC/Sludge into Bare Soil
Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12.CropType(s): _Z2nVMi4W_
13. Soil Type(s); AJA
14. Do the receiving crops differ from those designated in the CAWMP? D Yes [,2 No NA D NE
15. Does the receiving crop and/or land application site need improvement? Yes [2 No NA NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable Yes 10 No D NA NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
OWUP OChecklists [:] Design D Maps D Lease Agreements
M Yes
g No
[:] NA
E] NE
D Yes
allo
DNA
ONE
[:]Yes
SNo
DNA
ONE
[—]Yes
[ZNo
DNA
DNE
[30ther:
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes [allo [:]NA ONE
D Waste Application Ej Weekly Freeboard D Waste Analysis D Soil Analysis [:] Waste Transfers D Weather Code
M Rainfall D Stocking D Crop Yield [:] 120 Minute Inspections 0 Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes [S No NA D NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes ZI No NA D NE
Page 2 of 3 21412014 Continued

lFacility Number: �� - /J;' 57' jDate of Inspection: �t-
24. Did the facility fail to calibrate waste application equipment as required by the permit? F] Yes [2�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes SNo
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 allo
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes Z No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
E] Application Field E] Lagoon/Storage Pond 71 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?
F] NA NE
E] NA NE
E] NA NE
F] NA NE
F] Yes C3,No F] NA [:] NE
[] Yes 52 No [3 NA [3 NE
[] Yes 5�No [3 NA [3 NE
[:]Yes XLNo [] NA [:] NE
Yes
allo
NA
[D NE
Yes
10 No
NA
NE
Yes
jZ[ 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).
x1a4v /'o — ( —45"
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

(--Irbivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency I
Type of Visit: ffCompil nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eToutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I 'cf L5iD Departure Time: County: _i� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: jLIVOrr Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: 1D_V&4,0L C-90,ML Certification Number: '94
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.
I Layer I I
INon-Layer I I
Design Current
Dry Poultry Conacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
�tother
Discharges and Stream -Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: E] 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 M_No E] NA E] NE
Yes [D No E] NA [D NE
Yes F] No [3 NA E] NE
Yes No
Yes No
Yes R_No
NA NE
NA NE
NA NE
Page I of 3 21412011 Continued

Facility Number: i!&21 - j I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storrn storage plus heavy rainfall) less than adequate? [:]Yes CE-No NA [3 NE
a. If yes, is waste level into the structural freeboard? []Yes E] No NA [3 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?
(i,e., large trees, severe erosion, seepage, etc.)
[:] Yes Jallo M NA [:] NE
6. Are there structures on -site which are not properly addressed and/or Managed through a
Yes
5a No
F] 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
0 No
NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
[3 Yes
Z(No
E3NA
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
21 No
[3 NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
[Z No
[3 NA
E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. F1 Yes Z No [:] NA [:] NE
Excessive Ponding. [] Hydraulic Overload M Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
PAN M PAN > 10% or 10 lbs. Total Phosphorus E] Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window E3Evidence of Wind Drift M Application Outside of Approved Area
12. Crop Type(s): Aqc"'t�y_ -.;,i
13. Soil Type(s): AZZ 14�)aA Z611k
14. Do the receiving crops differ from those designated in the CAWMP? E] Yes J!�No NA E] NE
15. Does the receiving crop andJor land application site need improvement? Yes E�L 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?
18. Is there a lack of properly operating waste application equipment?
[3 Yes RNo E] NA NE
[] Yes Et No E] NA NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? E] Yes 4 No E] NA E] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes 1301 No M NA E] NE
the appropriate box.
E:]WUP E]Checklists M Design [3 Maps E] Lease Agreements []Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [:] Yes CR No
M Waste Application E] Weekly Freeboard E] Waste Analysis M Soil Analysis [] Waste Transfers
F-1 Rainfall [] Stocking [:] Crop Yield [_1 120 Minute Inspections E] Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? Yes fj� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes allo
NA [:] NE
Weather Code
Sludge Survey
NA NE
NA NE
Page 2 of 3 21412011 Continued

Facility Number: �V= - IR- T1 I Date of Inspectiow, W 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes CS No
25. Is'the facility out of compliance with permit conditions related to sludge? If yes, check Yes allo
the appropriate box(es) below.
E]Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Ej Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
No
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
[3,No
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Yes
2_No
0 Application Field E3Lagoon/Storage Pond F-1 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
No
34. Does the facility require a follow-up visit by the same agency?
E] Yes
[allo
F] NA C3 NE
[3 NA F] NE
NA NE
NA N E
[:] NA [—] NE
F] NA [:] NE
[3 NA [3 NE
[:] NA 0 NE
NA N E
NA N E
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: N-d—ZI
Date;
21412011

Type of visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /—),31 Arrival Time: Departure Time: County: Region: -�-
Farm Name: 1j jrr/ Owner Email:
Owner Name: Kn]Lyy Phone:
Mailing Address:
Physical Address:
Facility Contact: ��J�1cY. / /X ove i= Title:
Onsite Representative: SJ _
Certified Operator: V ip O P"
Back-up Operator:
Location of Farm:
Latitude:
G Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
-�
❑❑�.@
:
`-.
■
. \ \
--
:fib
■.IF
--
.:
_ \ --
A.�
_��' 1 £� � � i elf
C
� S
dF Fp;�1'
ii ♦q
■
_-
-�
� � '�4.-�
5
.
F.4#�
.-'�'
y
YkY.Y'y
■
■ 1
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes &No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes D�_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

lFacility Number: Fp-ateof inspection: lk22'��t�a
I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
rl"ZNo
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
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 immed,iate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
C] Yes
�Z No
[] NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit?
C] Yes
gZ No
E:] NA
E] 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
r;;n No
NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
E] Yes
MNo
NA
[3 NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes V1 No [] NA [:] NE
Excessive Ponding C] Hydraulic Overload F] Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
PAN 0 PAN> 10% or 10 lbs. Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window E] Evidence of Wind Drift E] Application Outside of Approved Area
12.CropType(s): zpac:4
13. Soil Type(s): WA-qe�a�z ko'gay 'o,0/7ca'k 'Ojal
14. Do the receiving cropAdiffer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Yes
Cff No
NA
NE
Yes
No
NA
NE
Yes
No
NA
NE
[—] Yes allo [] NA NE
E] Yes allo E] NA NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes R] No E] NA E] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes &No E] NA E] NE
the appropriate box.
[:]WUP []Checklists Design M Maps E] Lease Agreements E]Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. E] Yes E4.No
Waste Application [:] Weekly Freeboard El Waste Analysis 0 Soil Analysis F] Waste Transfers
Rainfall []Stocking F1 Crop Yield El 120 Minute Inspections E] Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:] Yes [allo
23. If selected, did the facility fail to install and maintain rainbreakers on irfigation equipment? [3 Yes Dg-No
F-1 NA [] NE
[] Weather Code
Sludge Survey
NA NE
NA NE
Page 2 of 3 2141,2011 Continued

Facility Number: 9�1— - /*0? 1 [Date of Inspection: &—.2
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes RNo 0 NA [:] NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check 0 Yes 5INo 0 NA F1 NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Fai lure to devel op a POA for sludge I eve] s
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
r_1 Application Field 0 Lagoon/Storage Pond 7 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 Eg No
0 Yes �g No
NA NE
NA NE
[:] Yes JK No [:] NA [:] NE
Yes 3;�No [:] NA E] NE
V_
0 Yes 53-No 0 NA E:] NE
[:]Yes E3-No 0 NA [—] NE
Yes C!J-No
Yes ��o
Yes TA No
NA ONE
NA C] NE
NA [-] NE
Comments (refer to question #): Explain any VES answers and/or any additional recommendations or any other comments.
use di�awings of facility to better explain situations (use additional pages as necessary).
v
-'P -6 - -' -n L3
i�rlc 0 !..v 0 — /I
Reviewer/] nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ZZ ;i�p/-
21412011

iA
PIKS VVJ 41131 J'�L,
0 Division of Water Quality
Fiaeflity Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit- (!Wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (SrRoutine () Complaint 0 Follow-up 0 Referral 0 Emergeney 0 Other 0 Denied Access
Date of Visit: M= Arrival Time: Departure Time: County:sofn
Farm Name:21 2) - Eoltla Owner Email:
Owner Name: 4kf Phone:
t
Mailing Address:
Physical Address: 11-1 b -0 LAf
Facility Contact: -i-ova- coanbf Title: MI)A,#,4 ff- Phone:
Onsite Representative: M)�V0-C6CMbrq-MV iloifvc�t Integrator: Prefa a I P
/ . t 1j
Certified Operator: SWL CWMb( Certification Number:
Back-up Operator: Certification Number:
Location of Farm.
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I ULayer I I - I
I I ]Non -Layer_ I I
Nc
PU
Other
Poults
Design Current
Dischar2es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [] Structure [] Application Field F-1 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:
Region: r/?o
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dly- Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:] Yes E No [:] NA 0 NE
C:] Yes [D No. Cj NA C] NE
[:] Yes C] No [—] NA [] NE
Yes
E] No
[1] NA
[-] NE
Yes
Eq No
E] NA
C] NE
Yes
Cff No
E] NA
[] NE
Page I of 3 21412011 Condnued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E] Yes Wo E] NA E] NE
a. If yes, is waste lev�l into the structural freeboard? [:] Yes [:] No F] 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 obsmed? [—]Yes Callo NA E] 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 Ca No NA F] 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?
[3 Yes
SNo
E] NA
E] NE
8. Do any ofthe structures lack adequate markers as required by the permit?
[3 Yes
Callo
[3 NA
E] 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
E3Yes
r5;17No
NA
E] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
[Z No
NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? I fyes, check the appropriate box below.
F� Yes
r3"o
E] NA
NE
Excessive Ponding [3 Hydraulic Overload E3Frozen Ground [] Heavy Metals
(Cu, Zn, etc.)
PAN M PAN> 10% or 10 lbs. M Total Phosphorus [] Failure to Incorporate
Manure/Sludge
into
Bare Soil
Outside of Acceptab e Crop Window Evidence of Wind Drift E] Application Outside of Approved
Area
12. Crop Type(s): tel�l CA , <41171*h 6vejed
13. Soil Type(s): Wa t � V 147
..j
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
[n:No
M NA
NE
15. Does the receiving crop and/or land application site need improvement?
Yes
CgNo
E] NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[3 Yes
RNo
E] NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
ft--"'No
L29
NA
NE
18, Is there a lack of properly operating waste application equipment?
E] Yes
Callo
NA
NE
Reciuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
CR-No
NA
NE
20. Does the facility fail to have all components or the CAWMP readily available? If yes, check
Yes
(0 No
NA
NE
the appropriate box,
E]WUP ElChecklists [] Design 0 Maps E] Lease Agreements E]Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. E] Yes ER No
Waste Application F-1 Weekly Freeboard El Waste Analysis E] So i I Analysis E] Waste Transfers
Rainfall 7 Stocking E] Crop Yield E] 120 Minute Inspections Monthly and V Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? []Yes No
23. If selected, did the facility fail to install and maintain rainbreakers. on irrigation equipment? Yes No
NA [—] NE
Weather Code
Sludge Survey
[3 NA NE
[RNA NE
Page 2 of 3 21412011 Continued

Facility Number: T2�, 113ate of Inspection: 41W
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
CR No
NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
F] Yes
ED-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
[R'No
NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
[—] No
CErNA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[3 Yes
1$;VNo
E] 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
�allo
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
tallo
N A N E
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
29 Yes
E] No
EINA NE
F1 Application Field E] Lagoon/Storage Pond 250thcr:S"�fm &Ljl�iqap
32. Were any additional problems noted which cause non-compliance of ti4e'rm"it"or CAWMP?
Yes
IV No
LOW
[3 NA NE
33. Did the Reviewer/] nspector fail to discuss review/inspection with an on -site representative?
F] Yes
ENo
[3 NA E] NE
34. Does the facility require a follow-up visit by the same agency?
[:] Yes
Jallo
[3 NA [D NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendationsor. any oth�r comments..
Use drawings of facility to better explain situations (use additional pag"��as'n'ece
s4ary),
C'U+ �/'Vjh bo"k 01 backs iolle 6-rr(-, / 4�7009 1 Sim e of +� if h'v be od
)F, FW, 3 h#T m'e,'o- b-ee, pwpdo� iiik's cutabov�twre_a y eAr 010(hara T'o�
weeds - 4%
aq. mil "�Od. cal'blAo"
kell *101'nW'4 -R('rm q_J00d re(&,df,
Nororpi wax d&7e_
j Soo).
Pfe*�
WAO's
Rev iewer/I n spector N am e: 'j-0 Phone: qlo-0-3300
Reviewer/[ nspector Signature: %r&� Date:Am I i i. m i)
Page 3 of 3 0 1 2141261

Facility No. Farm Name Date
y C,
Permit COC 0 1 C, NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
FB Oro S
Lagoon Name, S for spillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded (in)
Observed freeboard
Sludge Survey Date
7 Iq I I
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Q- A
Design Diam.-(ft)------�,
Soil TE.Ist Date Crop Yield Transfer Sheets
pH Fields Wettable Acres R&NaA14GE
Lime Needed WUP <�� incinerator
Lime Applied SyWeekly Freeboard Mortality Records
CU-1 L-"Zn-I in Inspections, Check Lists
Needs 9-(—S--1<25) ;�)120 min Insp. Storm W6ter
Needs P Weather Codes
Waste Date 101hl., 1,Z11A111 11411VIII I I I I
VA
FIRTZ
�M- I
rmo,
�.4
�Wng�IMI
0M.-
M
WnW',t'�- I�OVTSVK# eqT Jvvtra'T0-tj-
L
Verify P ONE UMBERS and affiliations
Date last WU P F R 0 19 FRO or Farm Records
Date last W UP at farm Lagoon # lq,,
App. Hardware Top Dike
Stop Pump�%'j
qj�- PumPS0,3
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 lb/ac

/H
W Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
1 0 Other Agency I
Type of Visit: WCompliance Inspection U Operation Review C.) Structure Evaluation () Technical Assistance
Reason for Visit: 19 Routine 0 Complaint "0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:111�201j!j I DepartureTime: County Region:
Farm Name: F-6-01 Owner Email:
Owner Name: Ho)'U'& Phone:
t
Mailing Address:
Physical Address: 113 � 44 L&,go— -Tvl k-ey
Facility Contact: _athA1'&_ CDQMh� Title:
Onsite Representative:
Certified Operator: '-J-61AVOL CO2nkf
Phone: q '21077 W
Integrator -
Certification Number: qv? Q0
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
]Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[:EL:ayer I I
I INon-Layer I I
Pullets;
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: E] Structure Application Field Other:
a. Was the conveyance man-made?
Design Current
Cattle Capacity Pop.
q2w-- __ -
_Pyi�
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes EgNo [] NA [] NE
[:] Yes [:] No [-] NA M NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Yes
No
NA
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
No
NA
NE
2. Is there evidence of a past discharge from any part of the operation?
[3 Yes
No
[DNA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[3 Yes
CffoN'o
E] NA
E] NE
of the State Other than from a discharge?
Page I of 3 21412011 Continued

IFacilit;'TNumber. 1%2�, - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes 5�No D NA D NE
a, If yes, is waste level into the structural freeboard? C] Yes D No D NA [:] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 00,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures obsmed? Yes No D NA D NE
(i.c,, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a D Yes 5j[ No DNA D NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
& Yes D No
D NA
D NE
8. Do any of the structures lack adequate markers as required by the permit?
D Yes K-,- No
DT
DNA
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 Ca No
D NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
D Yes No
D NA
D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes No
[:] NA
D NE
Excessive Ponding D Hydraulic Overload D Frozen Ground
D Heavy Metals (Cu, Zn, etc.)
PAN M PAN> 10%or l0lbs. D Total Phosphorus D Failure to Incorporate Manure/Sludge into
Bare Soil
Outside of Acceptable Crop Window [:] Evidence of Wind Drift
D 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?
Lj Yes
WNo
Lj NA
Lj NE
15, Does the receiving crop and/or land application site need improvement?
D Yes
Callo
D NA
D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
allo
D NA
D NE
acres determination?
17. Does the facility lack adequate acreage for land application?
D Yes
RNo
D NA
D NE
18. Is there a lack of properly operating waste application equipment?
D Yes
r5;j7No
D NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
gNo
E:] NA
[:] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
[>_j N o
D NA
D NE
the appropriate box.
DWUP DChecklists DDesign D Maps D Lease Agreements
DOther:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:] Yes
Callo
NA
[:] NE
M Waste Application [:] Weekly Freeboard [:] Waste Analysis D Soil Analysis
E:] Waste Transfers
Weather Code
D Rainfall D Stocking F-1 Crop Yield D 120 Minute Inspections D Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:] Yes
g No
[:] NA
[:] NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
D Yes
D No
qNA
D NE
Page 2 of 3
21412011 Continued

jFacill�'Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes Wo E] NA NE
25. Is'the facility out of compliance with permit conditions related to sludge? if yes, check Yes CRNo E] NA E] NE
the appropriate box(es) below.
Failure to complete annual sludge survey Fai lure to develop a POA for sludge I eve] s
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide docum6ntation 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
D Application Field E) Lagoon/Storage Pond M 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?
[D Yes
Callo
E] NA
E] NE
E] Yes
E] No
�? NA
NE
Ej Yes
CkNo
F] NA
NE
F] Yes CS No F] NA E] NE
F-1 Yes CErNo F] NA E] NE
[] Yes N No [] NA E] NE
E] Yes No
[:]Yes No
[:] Yes E�J-No
Comments (refer to'question #): Explain any YE& answers and/or any additional re6ommendations oiran
u se drawings of facility: totetter explain situations (use additional pages di nccessary).
-7,Pleaje, YIYA-a) OfOUCOvel- 6) Oaf'rldf- bm,�J- Of b"_ folc�;y
Yve(I YWAaW *Ijny (�jocd_ reco^d-f I
Revi ewer/] nspector Name: k11903 Schne-l'ift
Reviewer/Inspector Signature:
Page 3 of 3
NA NE
NA NE
NA NE
Phone:('?� jq �3- 3 �V
Date: lVap I& aoll
214120,6

Facility No. Farm Name Date Z211-
Permit COC OIC NPDES (Rainbreaker WA"T' nnual Cert
Pop. Design Current FB
Type Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
N's M-1-liviv,
Soil Test Dat C
pH Fields
Lime Needed
Lime Applied
Cu-I L.-Zn-I
Needs �
Crop Yield
Wettable Acres
WUP
Weekly FreeboaTj
linInspections
120 min Insp.
Weather Codes
Transfer.Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
�Ll�
ITT "-MnL af-WROTMEM
IN
N Amt (Lb/1000 GaIL
he Own �Aq 0-� a 11' 1
erif�rPHCME NUM6ERS and affiliations
Date last WUP FRO Date last WUP at farm
i FRO or Farm Records
'Lagoon #
.Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 lb/ac; Zn-I 3000= 213 lblac
App, Hardware

J16 1 Q 1
Type of Visit D Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ARoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ' Q Arrival Time: Departure Time: County: 6041102hRegion:
Farm Name: l74 B rOal-M Owner Email:
Owner Name: tj CU� Phone:
T
Mailing Address:
Physical Address:
Facility Contact: n Title: QAUr►ol Phone No:
Ousite Representative: Integrator:
a'�`
Certified Operator: 001hVg894ao
�-' Coo _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o ❑ 4 ❑ {1 Longitude: 0 ° =1 ❑ „
Swine
Design
@ap city
C*ur:rent
P�oWation
Design Current Design
Wet Poultry Capacity Population Cattle Capacity
C►urrcnt
Population
❑ Wean to Finish
I❑
Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
I❑
Non -Layer I
I
❑ Dairy Calf
gFeeder to Finish
q
❑ Dairy Heifer
Dny Poultry U ❑ Dry Cow
❑ Non -Dairy
❑ Layers ❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Pullets
❑ ❑Beef Brood Cow
Turkeys
❑ Turkey Poults
❑ Other Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
�.
Q�ther
❑ Other
- -Pufta t
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
U'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
7771
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CRNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ti;�No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

Facility Number: IS — 14g � I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [I Yes JWNo [I NA [I NE
a. If yes, is waste level into the structural freeboard? E]Yes El No El NA 0 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? [:1 Yes
RNo
El NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
0 No
El NA 0 NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? [:1 Yes
[RNo
[:1 NA [3 NE
8. Do any of the stuctures lack adequate markers as required by the permit? [3 Yes
tgNo
[I NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
�kNo
0 NA El NE
maintenance or improvement?
Waste Appjication
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes
"Dff'No
El NA 0 NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes
Dj�`No.
[3 NA [I NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
El PAN 0 PAN > 10% or 10 lbs 0 Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window El Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
El Yes
El Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El Yes
17. Does the facility lack adequate acreage for land application? D Yes
18. Is there a lack of properly operating waste application equipment? El Yes
�RNo EINA ONE
RrNo EINA EINE
[N�- No 0 NA El NE
JRNo [INA [I NE
;RNo [INA ONE
Comments (refer to question Explain any YES answers. and/or anyirec . ommendations,or, any otber'�,Orfiments 9�
n
Use drawings of facility to better explain situations. (use additional pages:as necessary):"
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 U 12128104 Continued

Facility Number:e,-A, —1'39 1 Date of inspection
Reanired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes RNo D NA El NE
20, Does the facility fail to have all components of the CAWMP readily available? if yes, check El Yes IgNo El NA El NE
the appropriate box. El WUP El Checklists [I Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes 5rNo [I NA El NE
0 Waste Application [:1 Weekly Freeboard El Waste Analysis El Soil Analysis 0 Waste Transfers El Annual Certification
El Rainfall 0 Stocking [:1 Crop Yield El 120 Minute Inspections E:1 Monthly and I" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? 0 Yes �jNo 0 NA [:1 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes []No (RNA UINE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
0 No
0 NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
fi'No
JWM
El NA
El NE
26, Did the facility fail to have an actively certified operator in charge?
D Yes
XNo
El NA
[I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes D No [�kNA El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
D Yes
RNo
El NA
E] NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
F-1 Yes
BNo
[:1 NA
[3 NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
CM
0 NA
El NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
D Yes
aN o
0 NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
NNo
D NA
0 NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
FrNo
El NA
[I NE
Additional Comments and/or Drawings: Altk
tn
4, iN�� , ""# J � qkk "2V
Svbs,11,fate_ 10fo hi — N cew,
jo oc�
-7, Bat Sfob Oti �
leaf e_ CLA or S' OvrhatqN h&:0C4Pj 01 b&�-Gfde_ Of 01>1
0 Id rf ef rya �'9. f V�ly meckao),ra) po.Wem
Piod v(e r bolhf �za ne'w reel oM call MA
74
Gwd Ito ktj --01/, Ot jcrd re(&-JS.
a- D I' i
Noknoi­(� Polve-co
'�['_L# I-ele /*
a DfV& OCK01 '14N,
Page 3 of 3 12128104

Fkiility No, 5-3-199 Farm Name
Permit � COC k-�
0 mmm
- 29 f EL/r± , Dateql�9110
OIC NPDES(Rainbreaker PLAT Annual Cert)
FB
Drops
Lagoon
- 29 f EL/r± , Dateql�9110
OIC NPDES(Rainbreaker PLAT Annual Cert)
FB
Drops
Lagoon
1
2
3
4
5
6
7
SpillwaL---
Design freeboard
Observed freeboard (in)
Sludge Survey Date
Sludge Depth (ft)
319
1
Liquid Trt. Zone (ft)
Ratio Sludge to Treatmqnt
Volume
i ,IV, Ld pm, 7;i Iff n, mo- 1011
EMMA
Soil Test Date
Wettable Acres 6./ RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
Weekly Freeboard Mortality Records 4.�
Lime Applied
1 in Inspections
Cu-I Zn 1
120 min Insp.
Needs 1:�—
Weather Codes--Z7—
Crop Yield
Transfer Sheets vi Itl
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon#
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-1 3000= 213 lb/ac
App. Hardware
I #,+ IV in

TypeofVislt '0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit qrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other C1 Denied Access
C:�7
Date of Visit: Arrival Time: Departure Time: 11;),"50 PtIl County:— 4ab, Region:
V
Farm Name: -I!L2 V:wm Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Mjhua- Copr�5 Title:
Onsite Representative:
Certified Operator:- —J-01,0—
Back-up Operator:
Location of Farm:
Latitude: =
Phone No:
Integrator3mei-figae,
�1/
Operator Certirication Number:AwA qR o
Back-up Certification Number:
=" Longitude: =0=1 =4S
Q'i g, �nCou rj r e esign 31 pejign it rjent
__ a. _ _ It 1-1 ----
M NI) —Rc ff i Uetl WRAM-8—me-Ft7YA �Pula-Mion r&"p—HCl1J-A
YA fik
A
—Wean
FO to Finish
101-ayer 1
0 Dairy Cow I
El Wean to Feeder
11:1 Non-Laycr
0 Dairy Calf
t3 F eder to Finish
I Qcf q0j
@103-1
0 Dairy Heifer
El Farrow to Wean
0 Dry Cow
0 Farrow to Feeder
0 Non -Dairy
10 Farrow to Finish
0 Layers
0 Beef Stocker
JO Gi Its
i 0 Non -Layers
0 Beef Feeder
0 Beef Brood Cow_'
.10 Pullets
Boars
Lj I urkeys
Turkey Pouits
10
1[:] Other
-
=m5fistir-UM-0-re-83 111,
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management systern? (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?
El Yes JqNo 0 NA El NE
[] Yes
[:1 No
0 NA
0 NE
E]Yes
ONo
[:INA
ONE
NA
(--] NE
El Yes
El No
0 Yes
;RNo
0 NA
El NE
El Yes
RNo
0 NA
ONE
12178104 Continued

Facility Number:�g
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes VNo El NA El NE
a. If yes, is waste level into the structural freeboard? El Yes El No El NA C NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: brV _%T( I(
Spillway?:
Designed Freeboard (in): Cl
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Yes 19 No D NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [I Yes DiNo [__1 NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes 5?No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? [:1 Yes RNo [:1 NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [I Yes JRNo EINA [3NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes CR-No 0 NA 0 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes R No [3 NA El NE
0 Excessive Ponding El Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
El PAN [:1 PAN > 10% or 10 lbs 0 Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
[I Outside of Acceptable Crop Window El Evidence of Wind Drifl El Application Outside of Area
12. Crop type(s) _Lda I &� I]& " S(o QL
13.
Soil type(s) N23 Is,, )VcA 15
14.
Do the receiving Crops differ from those designated in the CAWMP?
[:1 Yes
[5?No
El NA
[I NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
�No
0 NA
[I NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
CRNo
[__1 NA
0 NE
17.
Does the facility lack adequate acreage for land application?
Yes
IR No
0 NA
[I NE
18.
Is there a lack of properly operating waste application equipment?
Yes
CRNO
El NA
[I NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/I nsp�ctor Name -aoAN Scfl tj e i E 4- Phone: 210) �M-330QAXVV
Reviewer/Inspector Signature: Wt" Date: 002
V 1212tVO4 Continued

I - . �;
Facility Number: Date of Inspection IVIV091
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes ER No El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes 2 No E:1 NA El NE
the appropirate box. D WUP 0 Checklists El Design El Maps 0 Other
21, Does record keeping need improvement? If yes, check the appropriate box below. [I Yes 5allo [I NA 0 NE
Waste Application D Weekly Freeboard 0 Waste Analysis [I Soil Analysis El Waste Transfers [:1 Annual Certification
El Rainfall El Stocking El Crop Yield El 120 M inute Inspections El Monthly and I " Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[I Yes
'RNo
E:1 NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
JTNo
(RNA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
6a No
[:1 NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
04No
[:1 NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
[I Yes
5i�No
0 NA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
[I No
�3 NA
E:1 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
RNo
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
E[No
El NA
[__1 NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
RNo
El NA
El N E
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
;�Kj No
[I NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:1 Yes
RNo
[__1 NA
[__1 NE
33.
Does facility require a follow-up visit by same agency?
El Yes
ji[No
El NA
[:] NE
Additlonni Cot�ments-�nd/or Dia`wln'gs':,"�;",,'1- KV
. ', !U'�Ci
J
7. 1(eep �,Ork'(�y 0, bar-f 6V) ��Yoal d (4-e- VY0, s6At qsflyy4s."�Ce
rob I oil
6 coJ 'm �Wr
aq. Cal; brOWD..i
A
I w,0 I ry) 4 i* o� -00!,Y"4- re " Md -r,
Page 3 of 3 12128104

I . I "�
Facility No. Farm Name -W Date 611ao
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert
ENE
Lagoon
1
2
3
4
5
6
7
Spillw y
Design freeboard
Observed freeboardj!!�__
Sludge Survey Date
Sludge Depth (ft) & %
Liquid Trt. Zone (ft)
Calibration Date
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu _1Z Zn
Needs P
Crop Yield vj�L,4 pr*10"(f-
Wettable Acres
WUP
Weekly Freeboard v-'
Rainfall >1" �
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
WMEM&MMMMM =101M ��V, W#Jro7AM0"F
Pull/Field
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu _1Z Zn
Needs P
Crop Yield vj�L,4 pr*10"(f-
Wettable Acres
WUP
Weekly Freeboard v-'
Rainfall >1" �
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
WMEM&MMMMM =101M ��V, W#Jro7AM0"F
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
QA-
-�i—/
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
�FRO r Farm Records'�6/009
agggo'on # p
Top Dike
Stoppump
Start Pump
App. Hardware

Type of Visit -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit I.;tRoutlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time:�piT•'r Departure Time: County: Region: !O
Farm Name: Sa-a Palm Owner Email:
Owner Name: _71hf4_i� Phone: 5' 1) Ohba h
Mailing Address: �U QOK Iqt� crl)ii� N�
Physical Address:
Facility Contact: tnhw COif1b W4+fn itle: O)'t#'fff �1—Phone No:
Onsite Representative: Integrator: �r�s rat1P�L1lMs„_
Certified Op . _� hvatr CMM bc Operator Certification Number: AWA 9P920
erator• ,
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e 0 i 0 « Longitude: ❑ o ❑ i =
ig
Swine
Design Current
Capacity Pop elution
Wet Poultry
Design Current Design Current
Capacity Population Cattle Cap�ac�i�ty Population
❑ Dai Cow
❑ Dai Calf
❑ Dai Heifer
❑ D Cow
Non-Dairyw
❑ Beef Stocker
Feeder
Brood Cow
Number of Structures:ED
to Finish
❑ La er
to Feeder
❑Non -La er
r to Finish
$q
w to Wean
w to Feeder
to Finish
FBoars
ers❑Beef
Turke s❑Beef
J
Turke Poults
❑ Other
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 ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 tgNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes 15No ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12128104 Continued

�Facility Number: Ig 2k— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes RNo [__1 NA [I NE
a. If yes, is waste level into the structural freeboard? [I Yes El No [:1 NA [I NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): fa :?vf
Observed Freeboard (in): 211
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
RNo
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
0 Yes
CBNo
El NA 0 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?
OYes
[:]No
[:INA EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
0 Yes
19 No
El 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
[I Yes
FNo
[:1 NA El NE
maintenance or improvement?
Waste Applicati
10. Are there any required buffers, setbacks, or compliance alternatives that need
E]Yes
IRNo
[INA E3NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[I Yes
�3No
E:1 NA E] NE
El Excessive Ponding [I Hydraulic Overload E] Frozen Ground [1 Heavy Metals (Cu, Zn, etc.)
[] PAN []PAN> 10%or 101bs [I Total Phosphorus [I Failure to Incorporate Manure/Sludge
into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) C6 raty I le(m -d& (9 0_T
13. Soil type(s) Wag k 1-5 -NO.4,4 W"
I W-B
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
CRNo
El NA [:] NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
EjNo
[:1 NA [:1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
9No
[I NA El NE
17. Does the facility lack adequate acreage for land application?
E] Yes
Ej No
[I NA NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
allo
[I NA NE
. . . . . . . . . . . . .
an an commen atio so men
a ii i e
fM se.a I I ag.s as n c
;gommefitsl(reter Q6rqtl'��;
s a
e 4 'WliigS,Ofiflielllty�to,b'etter�'exp ;qa
nAA
Reviewer/[ ns pector Name qJ01133 - 3_PLV
Reviewer/Inspector Signature:- )0
I - Date: �) 1. 1. 4k
PaLye 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? E]Yes �RNo ONA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes JFK[No [:1 NA El NE
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps [:3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes PNo [:1 NA El NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis El Soil Analysis El Waste Transfers 0 Annual Certification
0 Rainfall El Stocking 0 Crop Yield El 120 Minute Inspections 0 Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
12 No
0 NA
El NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
[:1 No
12 NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No
[__1 NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
No
El NA
0 NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
5kNo
[:1 NA
0 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
F-1 Yes
0 No
[RNA
[:1 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
JRNo
El NA
0 NE
29,
Did the facility fail to property dispose of dead animals within 24 hours and/or document
0 Yes
2 No
El NA
0 NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
LRNo
0 NA
ONE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
J@ No
0 NA
0 NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
'R No
El NA
0 NE
33.
Does facility require a follow-up visit by same agency?
El Yes
1RrNo
[:1 NA
0 NE
Xilditl6n`ij�f,od A .0.4 ift
- - - ------ -- -- . .... .... .... .. . ...
f_ as Sf tead-
16
S aooql
oui-p &OM
7 W-,Nde- a, ael w
71 bae- I 0�' '
rivick s4ed-lai-tyeoll bk-+d1Jne,9f0W Wf1(QfL'?-_�0 dro:yA+,
w1e) I onpli 1) rds cm
Page 3 of 3 12128104

11
a
Chetk ito
Crtv
%ls ID a k-(T eltz-slv�ejl
Qqf o F?-�o
Ws- P",t.:- 50,3
- jo
T)
k-e — Fa - 0.
NO,,> o(fl 10,�P--dme-
C11% 9-64 CA I I bfo ct
of,yt,pe- Lye,
6azt4kl
rrov
4�
CcA � 610&,

:FF7cility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other E:1 Denied Access
—1
Date of Visit: Arrival Time: � Departure Time: I Oq "qD4j% County: 5A'y"*P5W'j Region: PIR-0
Farm Na me Rwm Owner Email:
Owner Name., 0 n g:w C ja�t Phone: 0/0)6was-017
Df I qk�'4"_' &)C_
Mailing Address: L
Physical Address:
Facility Contact: IJ- CDn—" Title:
n ;*. D _+
. . I �Fj vav . 1 14
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
JE1 Other I
11
Phone No-.(J/0&Z29-_70Z7
Integrator:&MIUM S4
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = Longitude: = 0 = I =
Design Current Design Current
Capacity Population WetPoultry Capacity Population
. ................ F .0 1
El ayer
I [UNon-Layet
Dry Poultry
D Layers . I
El Non -Layers
Pullets
Turkeys
urkey Poults
10 Other
Dischar2es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Cattle
Design Current
Capacity. Populati
El Dairy Cow
I
I
El Dairy Calf
I
El Daity Heifej
Dry Cow
Non -Dairy
El Beef Stocket
El Beef Feeder
w
El Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2, Is there evidence of a past discharge from any 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?
M
0 Yes EfNo El NA El NE
El Yes
El No
NA
0 NE
Yes
[I No
NA
El NE
0 Yes
[I No
EPNA
[I NE
El Yes
No
El NA
0 NE
D Yes
[P)No
[I NA
El NE
12128104 Continued

Micillty N u m her: Date of Inspection
Waste Collection & Treatment
C6
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
No 0 NA [I NE
a. If yes, is waste level into the structural freeboard?
El Yes
C1 No (:1 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
;rNA
S cturc 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5, Are there any immediate threats to the integrity of any of the structures observed?
D Yes
1� No [__1 NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
FJ No C1 NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation pases an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
[Z;No [3 NA El NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit?
0Yes
ONo [INA [:INE
(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
D Yes
allo 0 NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
�;No [:3 NA El NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
KNo [:1 NA El NE
0 Excessive Ponding 0 Hydraulic Overload [3 Frozen Ground [:1 Heavy Metals (Cu,
Zn, etc.)
[_1 PAN El PAN > 10% or 10 lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into
Bare Soil
El Outside of Acceptable Crop Window Evidence of Wind Drifi 0 Application Outside ofArea
12. Crop type(s) i3ef Mch @m�6 jm. 6r. QLW�
13, Soiltype(s)
I V
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
[�j No
0 NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El. Yes
4No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?[] yes
1P No
El NA
ONE
17. Does the facility lack adequate acreage for land application?
El Yes
[�LNo
[:1 NA
[:1 NE
18. Is there a lack of properly operating waste application equipment?
C1 Yes
P No
[:1 NA
El NE
Comments (refer to question #).- Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/ll nspector Name Phone: 19/0)#33-1200
Reviewer/Inspector Signature: Date: (g/243/0-7 !EE1
12128104 Continued

Facility Number: j3gL— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes M No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes No [I NA C3 NE
the appropirate box. I El WUP D Checklists El Design El Maps El Other P
2 1. Does record keeping need improvement? If yes, check the appropriate box below. Yes ftNo [3 NA [I N'E
V_
D Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis [:1 Waste Transfers El Annual Certification
El Rainfall El Stocking El Crop Yield [1120 Minute Inspections El Monthly and I " Rain Inspections El Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
0 Yes
[�No
[:] NA
[3 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E]Yes
No
EINA
[:1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the pen -nit?
El Yes
No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[_3 Yes
No
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
'c" No
LP
[:1 NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
Wo
0 NA
El NE
Otherlssues.
28.
Were any additional problems noted which cause non-compliance of the pennit or CAWMP?
El Yes
LA& No
El NA
El NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
�KNo
El 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 concem?
El Yes
PNo
El NA
E] NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
PNo
El NA
[I NE
General Permit? (ic/ discharge, freeboaTd problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
P No
[:] NA
[] NE
33,
Does facility require a follow-up visit by same agency?
El Yes
[PNo
D NA
0 NE
Additional Comments and/or Drawings:
�WM e4e t _Sjc_r9lv�5
12128104

Q
k' acility Numb.e.r.
*:Division,fif Watcr'Quality
abivis'lon of Soil"and Water Conservation:'
0�'Othcir'Ag�ency
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 0 Denied Access
I--,& d%
Date of Visit: Arrival Time: Departure Time- County: Region: r_71U
Farm Name; Cj4V.'%bS Fay_-M Owner Email:
Owner Name- co,),,mk_s Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: F70
Phone No:
integrator: Pre f " 11 WIA
Operator Certification Number:
Back-up Certification Number:
' I--] " Longitude: =0=S =ti
Design, Rurrfn4!
Des C nl
ign� Curr,.nt,l 'Current
IM6
!Swine" ti '�:.Catt e:." o ula'ti'o'n
Capacity Population Wet Pouitry, Capacity P6pu1A on --,#p
!J'c Acktyl
10
Wean to Finish
Wean to Feeder
Feeder to Finish
a,9 10
El
Farrow to Wean
El
Farrow to Feeder
El
Farrow to Finish
El
Gilts
El
l3oars
JEI Layer
10 Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
El Turkeys
El Turkey Poults
El Other
Discharges & Stream Imacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure El Application Field 0 Other
a. Was the conveyance man-made?
El
Dairy Cow
I
El
Dairy Calf __
1_ _ j
El
Dairy Heifer
Dry Cow
Non -Dairy
0
Beef Stocker
El
Beef Feeder
El
Beef Brood Cowl
N urn bee, of sir6du rei'e
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
[__1 Yes "No Ej NA [] NE
IN
El Yes
El No
M NA
0 NE
[]Yes
[]No
[�NA
ONE
VINA
CINE
[]Yes
[]No
0 Yes
�ho
El NA
El NE
El Yes
V No
El NA
El NE
12128104 Continued

Facility Number: E3.�_/99 Date of Inspection 1217-7
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):
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 are not properly addressed and/or managed
through a waste management or closure plan?
D Yes No D NA L1 NE
El Yes No [I NA [:1 NE
Structure 5 Structure 6
[__1 Yes IN No [:1 NA D NE
D Yes fA No D NA El 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? 19 Yes [:1 No [] NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? E]Yes PNo [:INA ONE
(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 [1 Yes P No D NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need OYes PNo DNA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, 0 Yes P No El NA El NE
El Excessive Ponding 0 Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
DPAN 0PAN>10%orl0lbs Cl Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window [:]Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) &'�: ry\w6 �a4 - S"'V &—rcq-, ow'U2't I L'i �� 4r- Am ud
13. Soil type(s)
A, , --n- . t-J,
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
P0 No
[:] NA
NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
D NA
NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre deten-nination ?
D Yes
No
0 NA
El NE
17. Does the facility lack adequate acreage for land application?
0 Yes
PNo
DNA
D NE
18. Is there a lack of properly operating waste application equipment?
D Yes
X1 No
El NA
D NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. i,
Use drawings of facility to better explain situations. (use additional pages as necessary);
Reviewer/inspector Name
144'ri, bl"n
PhoneX� U/0 V "192?m
Reviewer/inspector Signature: <V.
I A iZ1J4.%4&&'
Date: 0::e -29A
page 2 0j j 12128104 Continued

LFacility Number: 0.11, -19 11 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes No EDNA [D NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 4yes [I No El NA EINE
the appropriate box. AWUP El Checklists PS Design El Maps 0 Other .
wn
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes Vy No F-1 NA n NE
El Waste Application 0 Weekly Freeboard El Waste Analysis [I Soil Analysis El Waste Transfers D Annual Certification
0 Rainfall D Stocking El Crop Yield [1120 Minute Inspections [I Monthly and I " Rain Inspections El Weather Code
22. Did the facility fait 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 thepermit?
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 non-nal?
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
3 1. 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?
El Yes
CQ No
El NA
El NE
[I Yes
E:1 No
W NA
El NE
0 Yes
0 No
0 NA
D NE
El Yes
ED No
[I NA
El NE
El Yes
D9 No
Ej NA
El NE
El Yes
V2 No
El NA
El NE
El Yes LM No El NA 0 NE
[3 Yes 0 No [:1 NA El NE
El Yes R1 No 1:1 NA [] NE
El Yes JA No [I NA El NE
0 Yes
IN No
[:3 NA
0 NE
0 Yes
6Q No
El NA
El NE
Additional Comments and/or Drawings:
ok Prom 9 3 -0( 'P coorvbs ""S ctssUhn rtspns,14411 of-
-Par� , r
— Co ur� -k ssvws $
Page 3 of 3 12128104

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 El Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: 6ro
Farm Name: Fax e m (4 0,'YdA -or_e2 Owner Email:
C a At
Owner Name: Phone: 71cq— :�q- 2soo
Mailing Address: 0, R'U- - L01 AIC —283.2
Physical Address:
Facility Contact: Kaakc -----Title:
Onsite Representative:
Certified Operator.,
Back-up Operator:
Location of Farm:
Design Current
swine Capacity Population
10 Wean to Finish I 1 11
Ll,tTeeder to Finish I -;1410 1 1
D Farrow to Wean
El Farrow to Feeder
0 Farrow to Finish
El Gilts
Other
10 Other
CoAr"'e
Phone No: -9/0 - Eqsj— a/,7?
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = =I = 11 Longitude: =O=i =it
Design Current
Wet Poultry Capacity Population
Layer
Non-LayeT
Dry Poultry
Layers
El Non -Layers
El Pullets
Q Turkeys
El Turkey Poultsl
IEJ ther
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Cattle Capacity Population
Dairy Cow
Dairy Calf
El
Dairy Heifej
[I
Dry Cow
El
Non -Dairy
El
Beef Stocker
El
Beef Feeder
E]
Beef Brood Cowi
Number of Structures.,
Discharge originated at: [I Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes [allo El NA El NE
M Yes
E]No
[INA
ONE
El Yes
El No
[I NA
El NE
[:1 NA
[I NE
Yes
[:1 No
Yes
2No
[--INA
El NE
[3 Yes
2'N'o
(3 NA
El NE
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storni storage plus heavy rainfall) less than adequate? [I Yes Q<o El NA [3 NE
a. If yes, is waste level into the structural freeboard? El Yes [3 No F-1 NA El 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? El Yes ONo [3 NA E:1 NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed 0 Yes ZNo D NA El 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? C3 Yes 2'No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:1 Yes
2No
[I NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
ZNo
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
2"No
C1 NA El NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
[:1 Yes
2No
[:1 NA C3 NE
El Excessive Ponding [] Hydraulic Overload [I Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
[I PAN [] PAN > 10% or 10 lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge
into
Bare Soil
El Outside of Acceptable Crop Window D Evidence of Wind Drift [I Application Outside of
Area
".3 .2 1 r � 114-
12. Crop
type(s)
13. Soil type(s) ,Ld - A
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
9'No
[:1 NA [:1 NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
20N' o
El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
El No
El NA Q-NE
17. Does the facility lack adequate acreage for land application?
0 Yes
El No
0 NA 2NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
2No
0 NA [I NE
-�Otay P'n!) Oror movop&lj L- ---rod C /f"
-iS
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: -dir
12128104 Condnued

0
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 2<o [I NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes D-Ko 0 NA C3 NE
the appropirate box. [I W4TP El Chaelcti`sts [I D�Wh 0 U*re �] Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. Yes Q-N6 [:1 NA 0 NE
na ------ El -Soil AnItly 86 Cl )X&R-te :Promfers-0 AmmftFerrttftmtian
El-WasteApplie [I ee6y-Freebon [I-Wdste A ry--rnr
E]-�� E]Sfes"Pg- 0+34A4imft-ffispruM1Tn—s El thly and+H�a�=ions El V4uW=C=L-_
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 pertnit 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 non-nal?
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?
Dles
E:1 No
[3 NA
[I NE
El Yes
2090
C1 NA
0 NE
[I Yes
B'N"o
[:1 NA
0 NE
El Yes
[3'N*o
El NA
0 NE
E]Yes
(2rNo
El NA
[:3 NE
E]Yes
2�o
EINA
MNE
[:1 Yes
MNo
. [I NA
[:1 NE
El Yes
ONo
[I NA
El NE
El Yes
3"No
El NA
[__1 NE
El Yes
ErNo
El NA
El NE
El Yes
D"No
El NA
E:I,NE
M Yes
20<o
D NA
F1 NE
.�Aditwna'] Comme, nts"d/oirbrawlh s,,,
g
12128104
12128104

.aP�tJet.< -,t
lD�nsjan of Sol! and' Water Co"nservatzon €
U € r r 4 g„k
f � � �ii ,� �' ME � •u � 1 p t � - E II �` a� -�1 i�}� -__ � ° 1p ° - , '� t t � �
iType of Visit et,ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit tDrRoutine O Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number Date of Visit: Time: d
// 0 Not Operational 0 Below Threshold
M'Permitted Certified © Con!b;
tionally Certified [3 Registered Date Last Operated or Above Threshold:
' c 1
Farm Name: .�`.....�......1�..... :. ..!..4�'`.1................. County:........, D!�....................................................
nn,,_,, g 0
Owner Name: .................... 8 ..... C 4�S ....... Phone No:.......................... .....'�a. -7
...........
MailingAddress: ............ JJJJJJ......... b.i¢....................... ...................................................... ..... L.!'. N...,1......`....................................
Facility Contact: ..............'?p (..a``'...................... Title:.........Pw!�e.......................................... Phone No:.............. ...............................
Onsite Representative:.... �.. .4 ...�.....pH" �5...... Integrator:......... en-.D ^ ..... '" dw .........................
Certified Operator:................ fl . ...................... ! n! 4..................... Operator Certification Number: ^�;1.....
.. ........... ...... ..... ...:..............
Location of Farm:
I_✓l Swine ❑ Poultry ❑ Cattle ❑ Horse Ladtude �• �� �" Longitude �• �� ���
Discharges & Stream lmuacts
1. Is any discharge observed from any part of the operation?
❑ Yes Glq<o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other '-
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E lido
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes D416­
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1
Identifier: ...........................
Structure 2 Structure 3 Structure 4
❑ Yes
Structure 5 Structure b
Freeboard (inches):
12112103
Continued

IFacflity Number: Y9 — Date of Inspection 151-210 14
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes 040,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 Yes Eff'N'o
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? 0 Yes 2fio
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? El Yes M"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level El Yes &<o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? D Yes ETNo
11. Is there evidence of over application? If yes, check the appropriate box below, D Yes ErNo
[] Excessive Ponding [] PAN [3 Hydraulic Overload [] Frozen Ground [I Copper and/or Zinc
12. Crop type . fvm,.jj "VTr5p,,',J 104A)
13. Do the receiving crops diMer with those4esignated in the Certified Animal Waste Management Plan (CAWMP)? [I Yes 2No
14. a) Does the facility lack adequate acreage for land application?
El Yes
G?No
b) Does the facility need a wettable acre determination?
El Yes
E(No
c)'Mis facility is pended for a wettable acre determination?
ED Yes
RrNo
15. Does the receiving crop need improvement?
0 Yes
UNo
16, Is there a lack of adequate waste application equipment?
0 Yes
MNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
[] Yes
eNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
El Yes
CJ'Iqo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
El Yes
Er&o
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
0 Yes
[ErNo
Air Quality representative immediately.
xot�;hm 6W f r' 61 q
U, L., - . � 'I _... , .
r c ot
w*si­e mwyv-,4 f6 k..,, " CA.& 4, V,
W�41 (Y'TJ -r� ow rl,_
O&IS oft cfb 4 &qaj.
(�+ 'Iew, Lot,, 'f 14 U'�s C,4j
7
Reviewer/impector Name
Reviewer/Inspector Signature:
Date:
12112103 Condnued

Facility Number: Date of Inspection
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
ETNO
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
Grpo
23.
0 o
Does record keeping need improvement? If yes, check tthe appr 4e Eb o; xi—b e I �o
Yes
eN o
Y� =o,
[:]Soil S:pl g
[I Waste Application [] Freeboard [_-] Waste Anal in %J 40 A419P
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 yes
EKO
25,
Did the facility fail to have a actively certified operator in charge?
Yes
ff�40
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
V40
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
0 Yes
QNo
28,
Does facility require a follow-up visit by same agency?
El Yes
YNO
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
2*�o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
2"Yes
El No
31,
If selected, did the facility fail to install and maintain rainbreakers on irTigation equipment?
Yes
2fio
32.
Did the facility fail to install and maintain a rain gauge?
Yes
04o
33.
Did the facility fail to conduct an annual sludge survey?
El Yes
2<o
34.
Did the facility fail to calibrate waste application equipment?
El Yes
2<0
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
0 Yes
EKO
[]StockingForm Ej Crop Yield Form [:]Rainfall [:]Inspection After V Rain
M 120 Minute Inmectinn-, 1­1 Annual Certification Form
12112103

Site Requires Immediate Attention: 410
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA77ONS SITE VISITATION RECORD
DATE: 2 JAY 1995
Time:
Farm Ni
Mailing
county: set."Og�jew
Integrator: Ar;ts&e;gg C--av- re-% 5 Phone: —
On Site Representative: Z.Q4-_e. Phone:
Physical Address/Location: CS-AgZ '"a4
Type of Operation: Swine Poultry — Cattle
Design Capacity: - Z - p Number of Animals on Site: r­��
5 - .77
DEM Certification Number: ACE DEM Certification Number: ACNEW
Lafitude:_ Longitude:— * _'_"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) '�@ or No A t a] Freeboard: �Z Ft. _j::�__Inches
Was any seepage observed from the ff11n( s), i?yes OrUWas any erosion obsaqved? Yes or
Is adequate land available FDr spray? or No Is the cover crop adequate? Cyg�br No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin�' or No
100 Feet from Wells? o�r �p
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 ol(D
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or<9 If Yes, Please Explain.
Does the facility maintain adequate waste management rec
pa4 (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (&or No
Additional Comments:
�A-4 9;:�7
Inspector Name C/ / -7 7
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

.. 4
r-- �') FJ � ,
Site Requires Immediate Attention:
Facility No. . , Y w
DIVISION OF ENVERONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA71ONS SITE VISITATION RECORD
DATE: J7-1-11-' 1995
Time: 11.1 ;' (2 9
Farm Name/Owner: 10if e
Mailing Address:
County:
Integrator: Phone:
On Site Representative:- -Z., X17- Phone:
I lau
Physical Address/Location:
Type of Operation: Swine v/ Poultry Cattle
DesignCapacity: Number of Animals on Site: !�d)r 773e­
DEM Cerfification Number: ACE_ DEM Certification Number: ACNEW
Lafitude:— 0 Longitude: —
Circle Yes or No
Does the Animal Waste Lagoon hAyr, sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) ��`or No Actual Freeboard: 'i'" Ft. —Inches
Was any seepage observed from the lagoon(s)? Yes or(OWas any erosion observed? Yes or4q�
e or No Is the cover crop adequate? &or No
Is adequate land available for spray? (9
Crop(s) being utilized:_ (- ea da I Le - - -!4A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (ya or
100 Feet from Wells? g�or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes ore)
No
Is animal waste land applied or vray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 10
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(So If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
:e J ?ntin)&AAt;ovedj a5l
Additional Comments: la o
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

WORTH CAROLM DIEPARTKENT OF MMMM=qT, HEALTH' & HATMAL RESOURCES
DIVISION OF ENV:ERONHMTAL KANAGMaWT
rayetteville Regional office
Animal Operation Compliance Inspection Form
YAW,,.
1-�Yre. 1-41 t )Ary
..........
44.
TU - I o-� 19 6 C r
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
W-� �Ily �
Animal Qjparstion.%�Ma,-
Horses, cattle, $wine, poultry, or sheep
=ION IT
Y I N
1 . Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1, 000), .,and
poultry (30,000 birds with liquid waste
2. Does this fbeility meet criteria for
Animal Operation BMIDnATI
3. kre animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFPM
YAS7X MMaEMENT PT.
._ - —W
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

7,0
FigId Site ManacLement
1, Is animal wastg stockpiled or lagoon
construction within 100 ft. Of a USGS
May Blue Line Stream?
2. is animal waste land applied or spray
irrigated within 25.ft. of a USGS X&p
Blue Line St:CQaM? '
3. Does this facility have adeguatO aCrQ&9e
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CZRTIFICATIM RL-,W—.
s. is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(EMP) of the approved gnTTFjQTjQ_fi?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately
S. is the general condition of this CAFO facilitY,
including management and operation,
satisfactory?
figg.TIONM
=Fants

W 0
laccoon
wh^Re nearest relative is the
ri North America. It is
he raccoon is noted for the
ss the face and the black
tail. The rest of the fur is
wally nests in a hollow tree,
water. Raccoons eat a wide
)oth plant and animal. They
lrts, insects, crayfish, frogs
raccoon does not actually
as many people believe.
ten play with their food in
ster nearby.
ROY HORNE
From 421 Mill go to Turkey go straight across on 1909
for 1.4 miles take a left on 1911 go .3 miles take a
left on SR 1913 Farm is .5 miles on left.
1 D U A L I N
j
C 0 U N T Y

RZG;S7RAT:ON TCRX
Depazamenz of Ervircniment, Health -and Natural Resauzces
Division of Envizonmental Mamagement
Water Quality Section
= the
animal waste management system for
your feedlot weration
is
designed
to sex-ve mcre than cz
eqpal to
100 head
of cattle,
75
horses,
Z50 swine, 1,000 Keep, cr 30,000
birds that
axe served
by
a li;uid waste system, then =!is
fzrm must
A filled
out and. mailed
iy Oecamier 31; A93 pursuant z:
15A NCAC
2H. 0217 (c)
in crder to
be
deemed
pe=mi==edI by OEM. ?lease
print clearly.
Farm Name: 13 " A PCs n C-
xaning Adness: IP,(-x lqfe-C,
tow. kir 5
?hone
Owner(s) Name: 'RCL!4.
Xanager(s) Name:
lessee Name;
Farm Location (Be as specific as possitie: road names, direction,
milepost, etc.) Q". --- 11 . - C. �-' j'--9
Ir -,-) �O -C Cj I( j I�d J-QL�L�
r"�A It t - 1 4- r, I `% I-V-" I -'- - 1 j -"4-.
Lac i t ude / Long 1 tude i f known : r"03�� 4- 1 t4
Oesign capacity of animal waste management system Tu,mber and type
V ccnf ined ani=a! (s) co
Avezace an . =a! ;cpulatioa an the f a== (Number and ty=-e of animal (s)
7
.raised) : =11yu. via i
Year Production Began:_±19.3 ASCS Tract No.:
Type a f Waste manaqemen= System Used.;;"
Acres Available f or Land plicavicn of Waste:
Owner (s) S-,gnat,-"=e (s)

rem