820190_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Type of Visit: groom lance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: l(' IO Departure Time: County: C��1 N f Region: `, [
Farm Name: 'A Le �.(.T f uOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: e,,c ! ��1j�'L ''`' Title:
Onsite Representative: ` L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:r�S%
Certification Number: �� S4( 7 _
Certification Number:
Longitude:
Design Current11111
Design
Current
Design Current
Sw[ne Capacity Pop.
�'et out1
Capacity
Fop,
Cattle Capacity Pup.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Deslgn
Current
Dry Cow
Farrow to Feeder
P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
r
11ri
Turke PouIts
Other
Discharges and Stream lmt)acts
1. is any discharge observed from any part of the operation? ❑ Yes E3_X6_ ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes ❑ No [3`19A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑16 ❑ 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 A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes []--Wo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes F7Ko ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FX
Facility Number: - Date of Inspection: rt
Waste Collection & Treatment
14. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ 4to ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
Rectuired Records & Documents
No
Spillway?:
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑ Yes
[5
❑ NA
Designed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3lo
❑ NA
Observed Freeboard (in):
the appropriate box.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3 "'o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Q`No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Nom
❑ NA
❑ NE
8: Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� .. _
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift. ❑ Application Outside of Approved Area
12. Crop Type(s): ;�� ��� P" 'S
❑ NE
13. Soil Type(s): [�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [C[- o [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes r o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
to
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Q'l�o
❑ NA
❑ NE
Rectuired Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑ Yes
[5
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3lo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
o
rJ No
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?
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: JDate of Ins ectlon: T
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CIN,5— ❑ NA ❑ NE
+ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2 -No ❑ NA ❑ NE
the appropriate box(es) below.
�] Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
[] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ENo
❑ 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 En'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �lo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes F"; �o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2"No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: V ` l g
214120YS
l

NUL 11 6-t�
k:FDivision of Water Resources
Facility Number ®- Q 0 Division of Soli and Water Conservation
0 Other Agency
Type of Visit:7Routine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Timer County: U! Region: R-10—
Farm
`WFarm Name: 1a(I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C"V-+(3 Lia-V-JA)/IY " Title: Phone:
Onsite Representative: L` Integrator:
Certified Operator: 'l3 LoctLvtij Certification Number: IV -7
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish Lt
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Non -L
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Cali'
Dairy Fleifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EE11No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[TA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
O011TA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ~
❑Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412015 Continued

Facility Number: a Date of Inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [pi-'❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 I
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
C2 &o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
PTNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Z.cr m cco& S60
13. Soil Type(s): 1 o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [E`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�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?
0 Yes [ rNo ❑ NA ❑ NE
❑ Yes [TNo ❑ NA D NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [!fNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E!j No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EJ'No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility„Number: n Date of Ins ectlon: 10&E�ly
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0-< ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑YesNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes do ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [?"N'o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes YNo ❑ NA ❑ NE
Comments (refer to, question #):� Explain any. YES answe>•s'and/or any: additional.recoinmendations_or;anyother corninents <� j
Use drawings of facility to better explain sltuatio'gs,(use additional'pages as necessary).:­;5­
(3d
x; , i a
❑ Yes [%f No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes EA 0 NA ❑ NE
❑ Yes IVo ❑ NA ❑ NE
(3d (I r-Jfl” — 9_1 13 -
sj, 3,.te7 - I'fyo2R�-l�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
j1_-© —3 t � Lf, 6
Phone: , 1� C
Date: a �'"�Ll
2/4/2015

16
D vision oit Water Resources
Facility Number I� - O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O"Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 'IFIrk Region:
Farm Name:... `4i d Owner Email:
Owner Name: J l(f Phone:
Mailing Address:
Physical Address: r
Facility Contact: ,,�`� ( )(W(Title: Phone:
Onsite Representative: l
Certified Operator: Z UAC (A
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream Imnacts
Integrator:549�
T
Certification Number:
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
DaiEy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
[] Yes
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑A
❑ NE
K Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
Q'1<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q'lTo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[?11—o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 ��i/ 2/4/2014 Continued

Faci it' Number: jDate of Ins ection:_
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g -N'S" ❑ NA ❑ NE
a. If yes,' is waste level into the structural freeboard? [:]Yes ❑No [R�KA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E�Xo ❑ 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 2<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? []Yes �10 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [51No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes g; -No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Lg-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): e�l'✓�l *_,001
13. Soil Type(s): AAA
14. Do the receiving crops differ from those designated in the CAWMP? []Yes [ o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [T No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []?to ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�10
❑ NA
C] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑wdo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2'lro
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[30<
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes En No
❑ Waste Application [Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
�5�Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3 -No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [/] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

FacM6 Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g.M ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes PlNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3446 ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
91410'
❑ 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
[D>o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[g m o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q -No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ 1Vo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2 -No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional Daces as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
D • 3 6 j' P--oI
Phone:
Date:
2/4/2014

N
't" C434vision of Water Quality
Facility Number - PTO O Division of Soil and Water Conservation
Q Other Agency
Type of Visit:7Routine
Bance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:'-H--�� Departure Time: tJ County: ,% Regiod —7
Farm Name:
Owner Name: L
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �L� L } �q fCUctc.1">litle: � Phone:
Onsite Representative: �� Integrator:
Certified Operator: V/ro Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
F—ILayer
Non -La er
Design Current
Dry Poultry CapaCity Pon.
Layers
No n- Layer
Pullets
Turkeys
Turkey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Pop.
Daig Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ZP Ko ❑ NA ❑ NE
❑ Yes [:]No ENA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0A
❑ 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
ETNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D'1lo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Flo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

Facilit Number: Date of Ins action:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
L o ❑ NA ❑ NE
❑ No [ VA ❑ NE
Structure 6
Observed Freeboard (in): .3 0
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 [5<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [3No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 54o
❑ NA
❑ NE
maintenance or improvement?
[Vo
[] NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U40
❑ NA
❑ NE
❑ Excessive Ponding [] Hydraulic Overload [] Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): Bev -t v _ 96V
13. Soil Type(s): /VV V^
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes OX)
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes []No
[3 NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �""O
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�lo
❑ NA
❑ NE
❑ Yes
[Vo
[] NA
❑ NE
[:]Yes [/ No
❑ Yes [." No
❑NA ❑NE
❑ NA ❑ NE
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

•
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes af<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3_bi' ❑ 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 fait to provide documentation of an actively certified operator in charge? ❑ Yes ED,?,0b ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EVo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
��%%
I ifNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
TT'-""
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EDWb
❑ 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
C2"'No
NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E:rNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Eff]No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes LCJ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo ❑ 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).
Cit C SVG Ja t S�
Reviewer/Inspector Name: L1 1"-) u[4A PhVV - q33 - 333
Reviewer/Inspector Signature; - j Date: ar
Page 3 of 3 1/4/1011

�loal,a.
Type of Visit: (9'Compliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (3Y/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: 1 Q
Departure Time: ? O County: dS'A
Farm Name:
�,cr__xA m �{�Q 1I)
Owner Email:
Ute,
Owner Name:
m
�,dc jt;{� M!�j
Phone:
Mailing Address:
Region: _jr-pd
Physical Address:
Facility Contact: „QA.Tsf'_� AIk � r KTitle: Phone:
Onsite Representative: 0, ::��fh 1. -1 T t- �l. Integrator:
Certified Operator: Certification Number: 962
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Ycs ❑ No
❑ Yes ff No
[:]Yes [ /No
�NA ❑ NE
ENA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 214/2011 Continued
Ute,
rA■ 1- { elmFTM iM IV'"Ti�'-a
i,
Y�1 {..,a
:� r'.`4''.
■ r --
isx
}
--
�M 1
1
. I t
■ 1 MD.
41
0
� he Y � t.5.�.'€v.� � 'L8 i e
��
■
--
i § A ;..�.� f'� 1
xp;n
O�:.q STP $ ti- YL<'�.• N �`
.F
r
■ 1
--
j_� .f �S'
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Ycs ❑ No
❑ Yes ff No
[:]Yes [ /No
�NA ❑ NE
ENA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 214/2011 Continued

Facili Number: - 1 O Date of Inspection: S U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [g' -NA [] NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --#]—
Spillway?:
Designed Freeboard (in): t9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Cjj�No [DNA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes &No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes g No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
gNo
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[Ef No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
/
12. Crop Type(s): 4�i "L�'i`R UCC r KLA
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[yNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Repuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ o
C:] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
ED Yes
*[�Nvo
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑Design [:]Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No dNA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [✓]rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fNo ❑ 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 [5/No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No [D] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[Z�`No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
.53"'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E2�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
02/No
❑ NA
❑ NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
&❑
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑Yes
RNo
No
❑ NA
❑ NE
Reviewer/inspector Signature:
Page 3 of 3
Date: s'Z
2/4/201

ivision of Water Quality
Facility Number - l Ls.LJ 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ®'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q140utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name: I Llt.l "
i;;;._r IPA Owner Email:
Owner Name: -9'k Phone:
Mailing Address:
Physical Address:
Facility Contact: i"dl Title: �Li\ G , Phone:
Onsite Representative: -v�� _ Integrator: _ M
Certified Operator: B,lr + hUw►4 Certification Number: %q8�
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity, Pop.
Layer
Non -La er
ury Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
DaigL Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes No ❑ NA ❑ NE
[:]Yes
❑No
EKAA
❑ NE
❑ Yes
❑ No
2<A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
✓ NA
❑ NE
[:]Yes
io
❑ NA
❑ NE
❑ Ycs
B No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

IFacility Number: - = jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETINFo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � E] 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 2<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
U24o
❑ 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
<O
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FL34o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
LIGE<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
E No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[Ej<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop WindowEvidence of Wind Drift ❑ Application Outside
of Approved Area
12. Crop Type(s): t)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LI j o
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �fo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes B<O ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No jj<A ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej leo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [:]Yes Gg-<o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failurc 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 E3<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
IA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ea<o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
10
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
g] -<o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�10
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;31<o
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
[] Yes
E3<o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E3<o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. ;^
Use drawings of facility to better ex lain situations (use additional pages as necessary).
�tcS2 �GQ `1 w�� a -S I �tG�k--�tc� l✓- vt �5 t�+r
�leas� Cvr�t�+Nv-2. 6D W`r k' Ur— �trQ S�po'IS Gi-V
r
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
CLI..
Phone: 71e) "" 7-3,10r
Date:7/6j
2 4/2011

/o -05--7_00 i
Wision of Water Quality
Facility NumberSZ Y 1 _ O Division of Soil and Water Conservation
_.. _......--------- 0 Other Agency
Type of Visit QeCompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: c]'�g Dq Arrival Time: /� yS- Departure Time: O County: SAh.P-ra U Region: Geo
Farm Name: i3 dl 400 k 41"1 rMA Owner Email:
Owner Name: ��`7 LnGk(.t' M4� Phone:
Mailing Address:
Physical Address:
Facility Contact: C&J'413 090KW"C_r_ Title: 7e -d. Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
W an to Feeder
ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
=Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: =(=' =
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEy Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El -Beef Brood Cow
Number of Structures: U-11
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 -Ko' ❑ NA ❑ NE
❑ Yes
❑ No
C2 -9A
❑ NE
❑ Yes
❑ No
[J -17A
❑ NE
B -N -A
❑ NE
❑ Yes
❑ No
❑ Yes
❑'No-
❑ NA
❑ NE
❑ Yes
B'5o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 82
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -3 5 y
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?
❑ Yes LNo ❑ NA ❑ NE
❑ Yes [_7 �No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [R< ❑ NA ❑ NE
❑ Yes &f<o [:INA ❑ 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? ElYes E�< ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Se, -Ark 14t &1 � 6.4 to r, ',,, (0, S,
13. Soil type(s) ZVOA , LVO '18
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 21q -o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Ej-go ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes P o ❑ NA [3 NE
Reviewer/Inspector Name i % tv' %S -- 7_77� ] Phone: �9/0. P3„]'„33.35
Reviewer/Inspector Signature: nDate: V—/,g
Page 2 of 3 .12/28/04 Continued

. r
Facility Number: 92 — /9v Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl3 Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Leo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes D'No ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t-_fNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
91go
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
iso
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
,_, ,
Ngo
NA
[:1 NA
NE
[I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,E��
L7 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes io [:INA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9-110
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
5No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ YesNNo
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
9.5'5
❑ NA
❑ NE
12/28/04

3:rms 9 -o5 -o 8 R -R-
ivision of Water Quality
Facility Number D Division of Soil and Water Conservation
0 Other Agency
Type of Visit
ompllance Inspection
O Operation Review O Structure Evaluation
(Z) Technical Assistance
Reason for Visit
I31lo-utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
Date of Visit: g' 9~ o Arrival Time: /0! �3r Departure Time: / '% County: S42W dAJ Region: r�d
Farm Name:�lr/ii _�a rim a c., Owner Email:
Owner Name: B�ty L Op�'1 y� Phone: p
Mailing Address:
Physical Address:
J
Facility Contact: s �ur�lt K Title: �e`� SPS• Phone No.-
Onsite
o:Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o ❑4 =„ Longitude: [=0=4
❑
44
LL
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current, I
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: FTT.
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 3<o ❑ NA ❑ NE
El Yes
El No
[5NA
0 N
❑ Yes
❑ No
B<A
❑ NE
LANA
❑ NE
❑ Yes
❑ No
❑ Yes 8 -go-❑ NA ❑ NE
❑ Yes 915`5� NA ❑ NE
12/28104 Continued

Facility Number: gZ -/90
Date of Inspection 1.9-/9-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yesio ❑ NA EINE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 3 o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) --,��
6. Are there structures on-site which are not properly addressed and/or managed El Yes D o ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
�"No [1 NA El NE
9. Does any part of the waste management system other than the waste structures require [:I Yes L
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D<o ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
i � f
12. Crop type(s) (G,)
13. Soil type(s) /alp A MO S
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes E311o­ [INA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 01110 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes G-Iqo' ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes � El NA ❑ NE
[__1 Yes L� No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�
�
Reviewer/Inspector Name R� CI1S Re J e - S Phone: 9/0, f133 • 333P4
Reviewer/Inspector Signature: Date: e-
12128/04 Continued

r
Facility Number: SZ —/GJp Date of Inspection
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes <o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [:1 Maps El Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes B ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 -Ko_
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
l�of�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,D'l
LS No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2/o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2<o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
to
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
Yes
ElE
,--,�
El<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
.,/
3 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[:1 Yes
,��
LS No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 -N -o'
❑ NA
❑ NE
Se: I _ _ - Jc. `i d"F gg 9 Sq�,T� i�yyild! 'iw } 1�4�pp y Y:.�I}' f�YMS
A1dditional-Comments iin[I/qr Drawings '.kbJ. 5- 1w'A " i Y.§L�'`�.+.,�v.T �,.('•-.. -.1.
�A ,_�R '1 h�'i.i kR. 3: �'�:. 5 �':'75 1�`. Y'�y$F i.Y'b FRS•
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit &fompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 6<0utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ILfL_. J Arrival Time: Departure Time. �� County: Q____
Farm Name: /%%rte A"41L ur��ry � _ Owner Email:
Owner Name: 2h746 - --_ _ t'l1/i "' Phone:
Mailing Address:
Physical Address:
Facility Contact: / X~c %�f_l�/�n Title: Phone No: -3a�
�
ha 7 pm �. ►'ln`'✓�l'Y
Onsite Representative. _ �1! r°e Integrator:
Certified Operator: 7__/1 Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: =0
=4
= Longitude: =° 0 I 0
11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
rp f}Q Jg= I JE1 Non-Layet
Other
❑ Other - - {--- -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:IF-3
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence oi'a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes � No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,® No ❑ NA ❑ NE
❑ Yes 50 No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: q
Designed Freeboard (in): 19
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ,® No ❑ NA ❑ NE
[:1 Yes 19No El NA El NE
Structure 5 Structure 6
C1 Yes 0 N ❑NA El NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes rR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CO -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
Reviewer/Inspector Name �Y �---- Phone: V'_
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued
13.
Soil type(s) Zf ri�6
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[,No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[No
❑ NA
❑ NE
Reviewer/Inspector Name �Y �---- Phone: V'_
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

ff
' Facility Number: /qp Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IN No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
.Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EQ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�K No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
10 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R[No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JONo
❑ NA
❑ NE
Atlditional Comm'nts and/,or�Drawings�G"`���
Page 3 of 3 12128104
Page 3 of 3 12128104

1'
AD Division of Water Quality
Facility Number $•Z / %D O Division of Soil and Water Conservation
Q Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency () Other ❑ Denied Access
Date of Visit: !d •:OJ -Di Arrival Time: ; SQ Departure Time: Jb ; 2 County: a
Farm Name: i3; try L 6C, kam ` __ __ „ •,_,_ Owner Email:
Owner Name: o c/tawt., Phone:
Mailing Address:
Region: 1 --ft
Physical Address:
Facility Contact: Cur4t s 3(%VwiGK Title: t-. Phone No:
Onsite Representative: CUP4s 946-A // & Integrator: CoAak/ e-�sw_s
Certified Operator:
Back-up Operator:
Location of Farm:
1LJ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
Operator Certification Number:
Back-up Certification Number:
Latitude: =v =, Longitude: 0o 0, 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
ILJ Boars I I I
Other
`: ❑ Other
Dry Poultry
LaLa e--- ers —_
Non -Layers
Pullets
Turkeys
Turk�POUI
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design_ Current:"
Cattle
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
,ff
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes (9 No ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[B No
❑ Yes
EX No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: a —/go
Date of Inspection /4:�3�-Q7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. lfyes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
❑ Yes 8 No ❑ NA ❑ NE
❑ Yes % No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� -
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ®No [INA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PM No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CA No ❑ NA ❑ NE
mai ntenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
(p No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift El Application Outside of Area
12.
Crop type(s) u'Mc.t C 6 7 ) sm-0// !y'+7t: r✓ �O.SJ
13.
Soil type(s) pk-is//<
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
14 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
V No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
[m No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
I No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 1`�rc'K, izevC-�s Phone: CIZO, )K3.3• 3300
Reviewer/Inspector Signature: ga4S lSewc.ti1� Date: 10-03 — 206-7
12/28/04 Continued

Facility Number: gz —/'70 Date of Inspection /[1-0,7-07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CO No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[29 No
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[g No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[29 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

yr
L
f Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
n for Visit ® Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S I'O(O Arrival Time: //� Departure Time: County: Region: �2y
Farm Name: 1_nl�G6t A4 r'e— Owner Email:
Owner Name: IIs'//y _�DG/:a_hr �, Phone:
Mailing Address:
Physical Address:
Facility Contact: _ Si&4 Lo zkam,y 'Title:
Onsite Representative: _ CLP -hl ggrw ck
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: =0 =6 = Longitude: =0=;
00` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La ei
Feeder to Finish 29 42 3137
❑ Farrow to Wean
❑ Farrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: =i
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [§No ❑ NA ❑ NE
❑ Yes
[� No
El NA
El NE
❑ Yes
[�PNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[3 No
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: ;?2— /90 Date of Inspection s-a9_Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [9No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9",
Observed Freeboard (in): ;Z !;I a
5. Are there any immediate threats to the integrity of any of the structures observed? ElYes Lm No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [7 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
[� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[;9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V1 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[j No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) eel -Ata c.+ otla_ Swt� l' Grai,✓ l a Ve-M e-ci
go,
13. Soil type(s) /V.6 k-41 V_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[YNo
❑ NA EINE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[X No
❑ NA ❑ NE
rlownmimehts,(refei,�to questions#� Explaintttny YES answers-and/orfany}recommendaEions or any ot6cr commenings�of¢fnclng : ❑1��:. ., 3, ."I... < ;: � k- ,r..1�:t«x � et,.n- .;'aa ._ s s< <N., .n x,:vt..t`N 6 ak i " ai
Reviewer/Inspector Name r�i Guu ke-Ve 1s '- Phone: (q/o) Sf S(o %sy/
Reviewer/inspector Signature: re m Date: s— 619,— Z 00 (v
12/28/04 Continued

it s=o9-ol
Facility Number: Sz —1901 Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No M NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
WNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
29 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
iZ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(SNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�Z No
❑ NA
❑ NE
A 'dltional Corinments.and/n`r Drawings log
�f.� �k
12/28/04

I o
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: - / -D Arrival Time: Departure Time: County: - QOf do ^ Region: /7-170
Farm Name: G4c�la.nv F ren Owner Email:
Owner Name: aiz& LoaA Phone: �/4,} SG Vii- 439 S�
Mailing Address: -210 Loc/(ate,., /Qote --„ �A /01-7 NC. X9.129__
Physical Address:
Facility Contact: Cvrl_:.t 6Arw—,-e, R Title:
Onsite Representative: Cwe ,_s Qar'w►'c�C
Certified Operator: _ Le
Back-up Operator:
Location of Farm:
Phone No:
Integrator: _ d A&E,- r'e Fa1'Ak f _
Operator Certification Number: /98y2_
Back-up Certification Number:
Latitude: = c =I = Longitude: =0=4
°=4 0 +`
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
ElTeeder to Finish .�P4 if 0
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts i
❑ Boars--- -- -- - i
Other
❑ Other---- ----- -
❑ Layer
❑
Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
,E] ther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Elq<o ❑ NA ❑ NE
El Yes
[I No
0 N
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
[__1 No
❑ Yes
GlKo—
❑ NA
❑ NE
❑ Yes
Q -No
❑ NA
❑ NE
12/18/04 Continued

Facility Number: — Iqo Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [TNo ❑ 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?:-
jvu'c r 3 F AJ J/
Designed Freeboard {in}:
Observed Freeboard (in). �p,C" IlJ
5. Are there any immediate threats to the integri ' ❑ Yes 3lo [INA ❑ NE
(i e/ large trees, severe erosion, seepage, etc.)I
6. Are there structures on-site which are not pre ❑ Yes O No ❑ NA ❑ NE
through a waste management or closure plan t_ -
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
�o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RrNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
30f S-0
12. Crop type(s) j6e,,m ��e-Sn+d�� 6:r'& t'01
._
13. Soil type(s) &r &
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
E?' o
[:1 NA
[:1 NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
EK0
A
❑ NA
["NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
E] Yes
❑ No
❑ NA
[aNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[r3 No
❑ NA
l �i NE
18. Is there a lack of properly operating waste application equipment?
Yes
[:1I<
<o
❑ NA
❑ NE
Reviewer/Inspector Name ,/!��`.%( fi h " "�t� Phone: 9/a yIL-IS141Cmc><7sa
Reviewer/Inspector Signature: Date: 3
12/28/04 Continued

Facility Humber: — J90 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2'1�O ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Bio ❑ NA ❑ NE
the appropirate box. ❑ i'"r ❑ Ch fists ❑ Drest n�❑
21. Does record keeping need improvement? If yes, check the appropriate box below. ['Kes [--]No ❑ NA ❑ NE
/2-w-7 7.57
❑ Waste *pplication ❑ W ❑W��'...,.-;�, :e� ❑ SoitA r*sts- ❑ liaste'PrMfers ❑ 444nowl -Get
046RrPm ❑ steekirrg Crop Yield ❑ ns ❑ ❑ ..M��
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
Qlo
❑ NA
❑ NE
❑ Yes a% ❑ NA ❑ NE
❑ Yes 2 -No ❑ NA ❑ NE
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes
2"rNo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
Addltiunl Comments dlb"rDrawings
an
s.ax,�Xi....,nb,.s
�"�'$�a"�_
9/, I�ItAse keep a crop
y,e/e/ ?orrt,
12/28104

. 1 K
��IlfIr41
lit
j[.�,rf
Type of Visit 0 Com Ilance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: S O Time: ' DO
O Not O erational O Below Threshold
0 Permitted 13 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .....................
13
Farm Name: ............ ' il Loao
........F�......................................... County: ..........5.0-. so!....................................................
J e�, 3
OwnerName: .......................i. .......REQS �"......................n....i.................................. Phone No. ........ 9i?..1...:'...4.....95...................r.......................
MailingAddress:............lD.................. '�......... F.a................................ .....1.f�..H.........�......�................. A'lP.B....
FacilityContact:..................�`�............. L........Title:........411n�!!f!/..� ........................ Phone No:...................................................
OnsiteRepresentative:.......... .....QrW'............................................ Integrator:.........�ap+!`'!��.....................................................
Certified Operator: ............ ?41 ......................... .. . .... Loa ..... . ...............
perator:............!r,41...........................,.....Loa..................... Operator Certification Number:.... L 9 P° ................
Location of Farm:
dSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 0" Longitude • ' «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes 2<0
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 [moo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 20&o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ff Fo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:..................................................................................................................................................................................................................
Freehoard (inches):
12112103 Continued

Facility Number: ' — i o
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AURlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes BoNo
❑ Yes [r]No
❑ Yes QNo
❑ Yes MNo
❑ Yes RNo
❑ Yes [3No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes O No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type "k w4w*er (Ips
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 63'140
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes QNo
❑ Yes STio
❑ Yes 914o
❑ Yes QNa
❑ Yes RNo
❑ Yes ErNo
❑ Yes [+f'No
❑ Yes [ErNo
❑ Yes ET o
, � j
•w :.i. �. . 9 > t>'� .EE6".. 4. 'ia '.$: te;; .3. ,�I.€St,.,AE'• ,.. ,i ..t,: :t ! ".St.. itiE4i..'.-`Sr iriRi»;�E:';nrt,",§a3a "!'i .5$ i i' "Nt; 1 Y(
Commeats (refer:to,questaon'#) ;Explarn:ariy §YiaS:answers�and/or any{ re ommendations or;ady other co�iikhl{W .'s E EE,,((jjj "]]EEA�tt��EEt't,r, li
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S(.i'1 '!"3 d9 _'9§.'S. i'6 Y"°':S 1i': a 31�a to d Cap Final Notes
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Reviewer/impector Name 3�F' i � a" ` ' s
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Reviewer/Inspector Signature:—ALL Date: 51,9516+
12112/03 U Continued

Facility. Number: Date of Inspection EMU
WeQuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Ergo
❑ Yes E;?No
❑ Yes 'No
❑ Yes Effo
❑ Yes 214o
❑ Yes 314o
❑ Yes &No
❑ Yes RNo
❑ Yes Eallo
[Tes ❑ No
❑ Yes ff No
❑ Yes [TNo
❑ Yes Q'No
❑ Yes [R'No
❑ Yes [90%
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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12112103

Site Requires Immediate Attention: NA
Facility No. 8'a. - Vto
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 z_o , 1995
Time: 1'04
Farm Name/Owner: 3 •�l
Mailing Address:
C_ ZZ3Z-8
County: --
Integrator:_ ' . c;° r, o.�,_c._ Phone: _ 5ct�
On Site Representative: is •U�:j \.*CA<_w%-> Phone: S (V &t - G-5 C15
Physical Address/Location: _. to r`., w-hti, � t-�•�t�. ar. Loe�L�rr..� mol
Type of Operation: Swine ]!j Poultry Cattle
Design Capacity: 2�Lk0 Number of Animals on Site: 'IR +ka
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hAXe sufficie
(approximately' 1 Foot + 7 inches Yes or No
Was any seepage observed from thela oon(s)?
Is adequate land available for spray?es r No
Crop(s) being utilized: cc, a -t
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin Yes
100 Feet from Wells? Yes r
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or �1c
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Li
Is animal waste discharged into water state by man-made ditch, flushing system,
similar man-made devices? Yes o No If Yes, Please Explain.
nt freeboard of I Foot + 25 year 24 hour storm event
.ULual Freeboard: G Ft. Inches
Yes oNo as any erosion ob ed? Yes or No
Is the cover crop adequate. Yes or No
M
e: Yes o No
or other
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
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Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

FZGIST—, kTZON FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: r A",
Mail -,ng Address: - 3
County:. A-th O Phone No.
51
Owner (s) Name: PSA -Mtn
Manager(s) Name:
Lessee Name:
Farm Location (Be as specific aspossible: road namesdir ction,
milgpost, etr,.) OX, --4o AA: �4 /r.2
/�
Lac itude_/Long itude if known:
Design capacity of animal waste managelpent ste (Number and type
C : confined animal (s)) _ :19f,�1
Average animas nopulation on the farm (Number and type of animal(s)
raised)
Year Production Began: « ASCS Tract No.:
Type of Waste Management System Used: - . A, -
Acres Available for Land Appl' tion o ante: /�2
Owner (s) Signature (s) : DATE:
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