820193_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua]

IType of Visit: IFCom iance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: — / Arrival Time: Departure Time: ; "311 County;
Farm Name:r,%rrSs�,. t�j-14 :y Owner Email:
Owner Name: Cy��B�`�� /`em f� r���--�� Phone:
Mailing Address:
Physical Address:
Region: /C;-z Z)
Facility Contact: xune' Tz/ �/l Title: Phone:
Onsite Representative: Integrator: zY5/u�
Certified Operator: lj Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
La er
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Desrgn Current
Cow
Farrow to Feeder
Dr. P�oul Ca aci P,o
Layers
Non -Da'
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
_
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes No - ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[—]No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E] qo ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
FZ No DNA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

F'acili Number: - Date of Inspection:
Waste Collection & Treatment
` 4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E Na ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %91
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[a] No
❑ NA
❑ N E
(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
[3 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0--No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CffNo [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, 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): Lan f Bc�e✓� r`��
13. Soil Type(s): /' C A- / 907t Goa �F /Q /' A
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [3No
[—]Yes [3'No
❑ Yes []]No
❑ Yes 0- 0
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [] No
❑ NA
❑ NE
Required Records & Documents
"No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes El
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes [] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes E31No
❑ 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 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E"'No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: Date of inspection:
` 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 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 ErNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a] 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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other;
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [3 No
❑ Yes E]-'No
❑ Yes 0 No
❑ Yes Q No
❑ Yes dNo
❑ Yes FfNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer toy u tion:# Exp, hi ao ,Y�I;S a( se swers an
y y additional recommendations or an other comments.
Use drawings of faciil>i to better ex lam situations uadditional pages as necessa
Reviewer/inspector Name:
Reviewer/Inspector Signatuw
e► c�`n� T%1-c �`i r5! vU rt' � ��GL�- C �z'v!'1 rl2�r� J�6! O uJ C� d dd"'
e9,
ora�
y
Phone:
r
Date:
2141201 S
Page 3 of 3

Type of Visit: 'Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ty Arrival Time: Departure Time: County: S4 Region: r—
Farm Name: _(f P� _ Cc�t _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
k[
Latitude:
Phone:
Integrator: {r;3 —a c
Certification Number: 1-7 S- d l
Certification Number:
Longitude:
=ONE
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
DairyHeifer
Cow
Feeder to Finish
Farrow to Wean
Design C+urrent
Dry P,oult . Ca aci P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Gilts
Layers
Beef Stocker
Beef Feeder
Non -Layers
Boars
Pullets
Beef Brood Cow
Otheri.
Othfar
er
M„
I
-
z
I
Turkeys
TurkeyPoults
10ther
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? [:]Yes M6 ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No E! NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[—]Yes [:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes .�FNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility mber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�]�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a s [a —No ❑ NA ❑ NE
waste management or closure plan? "````YYYYYY
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
[DNA
❑ 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 rj'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes V 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 ❑ Ev' ence of Wind Drift ❑ Application Outside of Approved Area
12. Crop7 e s : oarsk
YP () � Ir`� � �3 �
�fllf
13. Soil Type(s): NO Go W%— D
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 [frNo
❑ 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?
❑ Yes [!f No ❑ NA ❑ NE
❑ Yes [7fNo ❑ NA ❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [AINo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E;lNo ❑ 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 KNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes UfN
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes vo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ETNo
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 ff rVo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1 'v4
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 CAW MP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes GfNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes EfrNo ❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
❑ Yes �No
❑ Yes ❑�No
❑ Yes KNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Date: -7 i5� L
21412015

.' f hv- A& !'-Z 31-1 tF g
► ivisioa of Water Resources
Facility Number ®- J 0 Division of Soii and WateNiue- ouse rvation
O Other Agency
Type of visit: GO -Compliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: �f�} U� Departure Time: ,1 j County: p~r, Region:
Farm Name:jUY�/�p�'"�J�b�'+., �� O ner Email:
Owner Name: _.Czy i- 4z.: � � 'TL� Phone:
Mailing Address:
Physical Address:
Facility Contact: , � d� «•- �1 Title: 40?!/!9 1r��`r Phone:
Onsite Representative: - /!c-i�r Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet_Poultry
Capacity
Pop.
Gattie Capacity
Pop.
Wean to Finish
11
Layer
Dairy Cow
Wean to Feeder
INon-Layer
Dairy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Ponl
Ca aeit
Po
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P�No C] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 X No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes JR No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - "-}
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _ l
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ®,No ❑ NA ❑ NE
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes 10 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 ®. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
inj
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Aaa6cation
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 "No
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
g 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?
IT Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
S No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[![ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes CgNo [DNA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 4; - - 1 — Date of Inspection- /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes fa No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes F. No ❑ NA ❑ NE
Yes [HNo ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
14 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Qj[ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[2�No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: /Z2?z�:1 14
21412014
Page 3 of 3

0
Type of Visit t!3'Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit O<Outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: - Arrival Time-
- p Departure Time: ', 3 l7 County: Region: fTG
Farm Name: Xr� ��f e(�S'"" �S�"` j �'� OwnerEmail:
Owner Name: Phone:
10,
Mailing Address:
Physical Address:
Facility Contact: a I� ��7Grso� Title: ©LIJn ter' Phone No:
Onsite Representative: _��.a-*—�-- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = A = Longitude: = o = 4 =
61
Design Cirrenyl
Design Current
Design Current
Swime
NEOPM
Capacity Population
Wet Poultry
Capacity Population
Cattle. Capacity Population
❑ Wean to Finish
10 Layer I
Dairy Cow
❑ Wean to Feeder
I
JE3 Non -Layer I
❑
Dairy Calf
Feeder to Finish
a01
❑
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑
Dry Cow '
❑ Farrow to Feeder
-
❑
Non -Dairy
❑ Farrow to Finish
❑ La ers
❑
Beef Stocker
❑ Gilts
❑Non -Layers
El
Beef Feeder
❑ Boars
El Pullets
❑
Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
Number of Structures:
❑ Other
U.
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
10 No
❑ NA
❑ NE
❑Yes
RNo
❑NA
❑NE
Page 1 of 3 12128104 Continued

t Facility Number: Date of Inspection �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ,❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Eallo
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ERNo
❑ 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
A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
JRNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[Z No
❑ NA ❑ NE
main tenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C.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)
13. Soiltype(s) ND7� 1 ��-n. VLIJE__P lot-23
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
�
[2f-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IM No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[R[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
Reviewerllnspector Name''` Phone` r33ao
Reviewer/Inspector Signature: Date: 9_o- _T _1;Z0t1?

1
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2!,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N[No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
g -No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PjNo
❑ 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
P 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
V,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
[0 No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

f
r
Type of Visit (D-Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: FT3,0 D County: Region:
Farm Name: �inrr lZ r`y— Ci — -5 s f'14 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: -��--
Facility Contact: f-7 0 Title: Phone No:
Onsite Representative: S.k Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ED e = { = N Longitude: = o = I 0 u
Design
DesignIIm--
Current Designpulation
Wet Poultry C*opacity
Population Cattle Capacity
Fopulation
❑ Wean to Finish
❑ Layer
E]Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
I
IE]Non-Layer
Feeder to Finish
a
❑ Dairy Heifer
❑ Farrow to Wean
rDry
Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cowl
❑ Turke s
Other ElTurkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes &No ❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[21 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: — Date of Inspection D9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑ No ❑ NA ❑ NE
Stnteture I Structure 2 Structure 3 Structure 4
Structure
i Structure G
Identifier:
Spillway?:
Designed Freeboard 60: g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
®No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
]RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
[& No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
XNo ❑ NA ❑ NE
maintenancelimp'rovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
;K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s) VQAZC --1 Dl E_,.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D.No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2 No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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):
i
Reviewer/inspectorName Phone:
Reviewer/inspector Signature: Date: ct~
12128104 Continued

1�
Facility Number: — 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 29-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [.NO ❑ NA ❑ NE
the appropriate box. ❑ wup [] Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [j�No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ 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
[2 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
jKNo
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
fiqNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additwonal Comments and/g000wings�
12128104

Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r Departure Time: �12r .3 County: �� Region:!
Farm Name: �� a''"/ l Owner Entail:
Owner Name: Phone:
Mailing Address:
Physical Address: I
Facility Contact: T'iil ���9�S�`�' Title:
Onsite Representative:
Certified Operator: sA-.-►.�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: a o = =64 Longitude: = o =' I=] u
'
Design
x,ITk
Current
Design ° Cum en
Design Current
Swine Capacity
Population Wet+Poultry
Gape_ city hon
Cattle Capacity Population
❑ Wean to Finish
❑ La er
�P�opul
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Weeder to Finish
—U a =
r ;;tea:
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
°=
❑ D Cow
❑ Farrow to Feeder`
El Layers
❑ Non -Dairy
❑ Farrow to Finish
Non-LayersEl
El Beef Stocker
El Gilts❑Beef
Feeder
❑ Boars
El Pullets
10Beef Brood Co
❑ Turke s
f" :.
Outeu.
r ❑ Turkey Poults
❑ Other
K.10Other
INutsiber
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes V No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
CKNo
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
�&No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? JC Yes
IgNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
J.No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes
®No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�&No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ld% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s) J(f Z�L� / '_X f 0P 05
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
[NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
IRNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
Reviewer/Inspector Name' . 6-�-- Phone: 33 — 300
Reviewer/Inspector Signature: Date: Da
Cage t qj -) lZ/ZaivV • uniinuru

L,
Facility Number: — Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes %No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �&No ❑ NA ❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�BNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;9-No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ESNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9[No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;&No
❑ 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
allo
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RjNo
❑ NA
❑ NE
Page 3 of 3 12128104

r'
QQ 49115lvision of Water Quality
Facility NumberUT:�—"n 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit
ommpliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Glioutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: r Arrival Time: : 2T5 Departure Time: Q County: Region: f�
Farm Name: f�xa_,L j .. L�7;; SDj`i tf'�` .c yOwner Email:
Owner Name: V Dom , fix'=-aL ' �l`� t7''� Phone:
Mailing Address la
Physical Address: /f
Facility Contact: ,l�e ��a{ Te ri-M sip i, Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone
No:
Integrator:1�'-'��
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 [::] ' 0 " Longitude: 0 ° [—] , ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -Laver
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
I E�]
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
❑
DEY Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ET-1.
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 J0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
El NA
El NE
❑ Yes
,Q No
❑ NA
❑ NE
❑ Yes
(9 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® 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 f9] 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 C+No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ER 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 [4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EgNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JZ 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
JWindow
/ ❑ Evidence of Wind Drif9 ❑ Application Outsides of Area
12. Crop type(s)/�I.i r�/>/J�e-�— �1'hlu,%�Ut+���1•
13. Soil type(s) J�/7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
fi� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
fZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0-No
❑ NA
❑ NE
Comments (refer to question ft 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 ✓ Phone:j_--
Reviewer/Inspector Signature: Date:
I7/7R/Ad /'nNf;N1104

• Facility Number: A2 — Date of Inspection 7 �
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 O-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 allo ❑ 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
®.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
.Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
14No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�9.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ 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
S 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
KNo
❑ 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
f9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
A No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

t
Type of Visit: EJComphance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: (3r outine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: }"iS` Arrival Time: C?,' Departure Time: �J'] County:�Region:
Farm Name: ±,_ � clii %`y Owner Email:
Owner Name:-1,j �rl �►'S 9Phone:
Mailing Address:
Physical Address:
Facility Contact: ,ram �/ �i-- Title: e9LUy �sr` _ Phone:
Onsite Representative: ���� Integrator: /t
Certified Operator:
d
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude -
Design Carrent design Current
Design Curreat
Swine Capacity Pop. Wet Poultry Capacity' Pop.
Cattle Capacity Pop.
Wean to Finish La er
DairyCow
Wean to Feeder Non -La er
DairyCalf
Feeder to Finish
l7
DairyHeifer
Farrow to Wean
��'' Design Current
D Cow
Farrow to Feeder
D . Pouf I Ca caiiy P,o .
Non -Dairy
'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other i
TurkeyPouets
Other
Other
ilil1.. �M f�
Discharves and Stream ImnaetS
1. Is any discharge observed from any part of the operation? ❑ Yes [� No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes R No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes qNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility ]Number: Date of inspection: �
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5�_No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9'�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ 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
J. 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
ELNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
;kNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[2,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Q�'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Crop TYPe(s): /
.12. -ow"Jea
c­,,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[,No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ®-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: JDateof Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes KI No ❑ NA ❑ NE
❑ Yes [3,No ❑ NA ❑ NE
❑ Yes Ld=k ❑ NA ❑ NE
❑ Yes [R[No ❑ NA ❑ NE
❑ Yes N o
❑ Yes [ No
❑ Yes ff�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
li' end Comments ` of fac�l� to better ex lata situations Viers and/or any alas n ndations or anyother e�ouients.
(refer to q on:.) Explain an YES answers additional' a es dttibnai r ry mme
p (. p g essa
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 5/o—?9 3
Date:
21412015

Type of Visit: O-Coroutine
nee Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: Departure Time: (; O a County: Sa.,, errs Region:
Farm Name: ��� ��z-/� �> �,;x S l --- la Owner Email:
Owner Name: �Ti•� r9���n/ j 15 y-- Phone:
s�
Mailing Address:
Physical Address:
Facility Contact: Kp--,ja4j �rs _Title: zqC,un Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
EM
Design_ Current Design Cyrrez,t- _
Capacity Pop WetPopltry Capacity Pop. _
Desiga Current
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
-
rSwine
Wean to Feeder
Non -La er
Dai Calf
Dai Heifer
Feeder to Finish
r.
rrent
D P u[tr Ca act ,fiPo P.
Farrow to Wean
Dry Cow
Farrow to Feeder
Non-DaiEy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
113eef Brood Co -
Other _ �a ; _
F" Other
Turkeys
Turkey Puults
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? [:]Yes 0,No [DNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes MNo
❑ Yes E[ No
❑ NA ❑ NE
❑ NA FINE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
' a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
® No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): C
Observed Freeboard (in): Z-
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes 0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® 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 ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ID 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 5�[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [N�Vo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[. No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
K No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ANo
❑ 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 [Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: — —/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6a No DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fallo ❑ 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 [gNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ 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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [2jNo ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes allo DNA ❑ NE
❑ Yes No
❑ Yes ® No
[—]Yes [!�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ty_?J�Vd a
Date:
21412014

Type of Visit: tDTompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: D- (,--/ Arrival Time: ,`(Ja Departure Time: ! p County
Farm Name: 6:leo ��/ r�,���---.- �Qln�� Owner Email:
Owner Name:7�:_r..,v---- Phone:
Mailing Address:
Region:jc:::jZ (�
Physical Address:
Facility Contact:Gr✓" %%1 jOr-t� Title: Phone:
Onsite Representative:. Integrator:
Or
Certified Operator:PL_j-3tr-- Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design
Current
5wiae Capacity Pop.
Wet Poultry
Capacity' P P: Cattle
Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
' `•* Dai Heifer
Wean to Feeder
Non -Layer
Feeder to Finish
D
`% Da
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Dr. P,oult ,
Ca aci -,P-,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Beef Brood Co-,
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other
T ey Poults
Other
Other
U—_ ,
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)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any pan of the operation? [—]Yes RNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes U3�No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

f-FacilityNumber: 42- Date of Inspection:
Waste Collection & Treatment
•4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z�No [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): h_
Observed Freeboard (in): 71
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [g 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 2[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes RLNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurOSludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ,�, - k U rer- jr--J
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes O No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes O No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Jallo
❑ 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
F 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
to No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: G �/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 5A No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ICE
r.
❑ Yes En No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [�Na
❑ Yes [�j No
❑ Yes [a No
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings offacilityto better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
s
Phone:
Date: /p /G a 0l y
21412011

a
Date of Visit: —/3 Arrival Time: ; Di'] Departure Time: County: _iiRegion: P�7_ j3
Farm Name: %,�g.,�.P� �� g� -j�S S Fezi / "41 Owner Email:
Owner Name: (�7.���,! f �3 p� �- Phone:
Mailing Address:
Physical Address:
Facility Contact: � �s try Title: Phone:
Onsite Representative: Integrator: 'eIS " e.
le
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
'Design
Design Current
Design Current
Currents
Swine Capacity Pop- WetPoultry: Capacity
Pop
Cattle Capacity Pop.
Wean to Finish La er
Dairy Cow
Wean to Feeder
Feeder to Finish
on -Layer
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D gn
D , 2Pxoult , Ca' aci
Current D Cow
P.o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Beef $rood Cow
Pullets
Turkeys
- - -
Turkey Poults
Other
Other
- =
Discharm 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
[—]Yes [:]No
[—]Yes ® No
[-]Yes 2C No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3
21412011 Continued

]Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? E] Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes FZ] 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 [0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes gl 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 RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [TJINo
❑ 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): �/' 0%_ f � S ,�.�-.�� ��I,U2 i� L4pptr
13. Soil Type(s): ��SO ZALZ/112--h —. .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes ENo ❑ NA ❑ NE
❑ Yes -[j�[ No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PS No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design [-]maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

' Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
10 No
❑ NA 0 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
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
allo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[K 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ®, No 0 NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes [ZL No
❑ Yes ® No
❑ Yes C,No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �y y33 'j3cDa
Date: 13
21412011

L
Type of Visit: 91Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ; DO 7 lCounty
Farm Name: ����� ��--f�sb 5 �m Owner Email:
Owner Name: �-y_jy►y` ��� �� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: A�mz&� /-1-3 Title: �t�� �I _ Phone:
Onsite Representative: Integrator: 1-1-
Certified Operator: Certification Number: �
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region:
Desigu Current
Swine .. Capacity Pop.
g °`=
Wet Poultry
Design .Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
ir
Layer
Non -La er
�Dr P,oul
La ers
Non -Layers
Pullets
Turkeys
Turke Poults
Other
Design
Ca aci
Current
Pao
DairyCow
DairyCalf
DairyHeifer
Cow
Non -Daily
Beef Stocker
113eef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JRNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

5
� Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
[allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
�&No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tA No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Application Outside of Approved Area
❑ Outside of Acceptable Crop Window ❑ Evide:�L2
12. Crop Type(s): �//?
13. Soil Types}: U L r ,!) r h
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [A No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? I f yes, check the appropriate box below. ❑ Yes �Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CZ No ❑ NA ❑ NE
❑ Yes f4 No ❑ NA ❑ NE
❑ Yes 0[ No ❑ NA ❑ NE
N-yes $4; V [DNA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Use drawingComments s of faeiferjb lty to' bet" er a pla�n,s fast ons (dse additto a1 pages astiona1necessae)mmend�#to�ns'��or'"anyfiotpc` o�nmen`ts: `
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone: //.67
Date: 7
21412011

Type of Visit: ,romnfcpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Beason for Visit: t' outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �� �—) Arrival Time: Departure Time: ; p County: Region: T �L
dv
Farm Name:A�� �`"fl—s,,.r— Sg�� 1-41 Owner Email:
Owner Name: �����r'/�,.` Phone:
Mailing Address:
Physical Address:
Facility Contact: ��gnB r+/�rY,� Title: e26g2,n/ Phone:
Onsite Representative: Integrator:
Certified Operator: f'41�Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current � �Destgn�Ctirrent
Design Current
Swine Capacity Pop. Wet Poultry Capac ty Pop
_.. .. ...
•
Cattle Capacity Pop.
Wean to Finish Layer
Dai Cow
Wean to Feeder
I JNon-Layer
I
lf
Feeder to Finish
O
Da' Heifer
Farrow to Wean
Design.,
Current
D Cow
Farrow to Feeder
D , P.oult . "'kCa acl
Po
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
IBeef
Brood Cow
Turkeys
Other
Turkex Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes ®No ❑ 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 1 of 3 21412011 Continued

Facility Number: - 3 Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E. No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
to No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ljq-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s):
13. Soil Type(s): p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes jo No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ,® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[—]Yes
&a No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
54 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E) No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [-]Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
ELNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: V=- Date of Inspection: 11
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g No
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes RNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes JZ] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
54.-No
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
54 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
63 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: OD
Date:
21412011

u
Type of Visit @, ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: — --a?}{v Arrival Time: `OC7 Departure Time: County: Region: (�-
Farm Name: � •�" / C/�S an' t s_OVI-5 Owner Email:
Owner Name: G-ey /-a c. R-o" EC'Phone:
P,
Mailing Address:
Physical Address:
Facility Contact: T i .-L. Title: "
Onsite Representative:
Certified Operator:
Back-up Operator:
Phoonnee No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =, = 66 Longitude: = ° = r ="
Design Current Design
Swine Capacity Population Wet Pou!#ry Capacity
C•urreut Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
iry Calf
21 Feeder to Finish
.20
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Layers
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars El Pullets
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other ❑ Other
❑ Beef Brood Cowj
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
kNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
KNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
XNo
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

'
Facility Number:
Date of Inspection 6
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
2�No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 (�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
qNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
,d 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
allo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
MNo
❑ 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
Z No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fiQ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
A No
❑ NA
❑ NE
0,7 C'- 7 �u L�D��� - L11
Reviewer/Inspector Name* 4��'L �z " �" �"� Phone:
Reviewer/luspector Signature: Date: (`vY tJw
!L/40/V"I - VVlecon"CU

41
Facility Number: 111 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
54 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jN No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ANo
❑ 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
KNo
❑ 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
0? 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
24No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Fact{lityNumbeir,
� Y '
® Division of Water Quality
O Division of Soil and Water Conservation.
O Other Agency"
i 1-�•
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: %.'S'o Departure Time: County: SOL— osekl Region: F"
Farm Name: ROP71h f� P &—,# an 'Pe— Seas rrp+_ AAI— Owner Email:
Owner Name: _ R o"d 1 aQ P�+G�ss� __- Phone: Cq ! O� S9a - S 3 G1
Mailing Address: `YTS !.c/ %Yf Co_;Je- . ._ _('��,�.+ e K� /V C 028 3.2
Physical Address:
Facility Contact:
Title:
Onsite Representative: K ar,a etf
Certified Operator: R ra hd \ OL P �^ c.-, a 0
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E:1 0 0'= Longitude: 0 0❑ 6= .6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
e? 91V0
2 73D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ i_a �crs
❑ Non -La ens
❑ 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
I
i
❑ Dairy Calf
❑ Dairy i-leifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coy
i
i
Number of Structures: 5
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 ofthe State
other than from a discharge'?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
�s
12128104 Continued

Facility Number: g.2 — 19 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: G::%
Spillway?:
Designed Freeboard (in): _ '_-7c9.?• L p '7 /o? JP/ $a.
Observed Freeboard (in): 'f'trJ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[� No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[9 No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Od No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) Co,,, . wked6 4- . sa 4 L#_g"i t Co A. • 4'
13. Soil type(s) No /� . d a /�. Wa a$ . no- B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(A No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
$a Yes
❑ No
❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
U 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
[)a No
❑ NA ❑ NE
0 w C P'I� d A 14/60Aj Mat& — 5Pat-t.
�� l p �C dr 4 f G Meal 4 v 0 1,(-,,te_ rZ O d r! d h -t-L a ,% r a d j G_,
p �s ilk J<. � pY�., �,�+� � c..,e� .y c ifs
ReviewerlInspector Name iLsL
Yk
XT"
Phone:
Reviewer/Inspector Signature
0_17�
Date: y/pr
11/18/04 Continued

Facility Number: g,Z — Jq3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [J] No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking �Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
® Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® 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
91 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® 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
El 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
91 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
x❑ 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
m No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VI No
❑ NA
❑ NE
v� j -� T i e a• c. L - ,: •• �r a u a e tL. C rn p \ i C IA Zra .,." }-o r eLor'&4_
�ofbro.Au.cAIa&34 '1_r t,r- :rc�
12128104

0
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 4IRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility- dumber
Date of Vicit: ,9-3 p Time: 15,0 7,n7
s`t• I
ro
��..,, �� not Operational Below' Threshold
[�ermitted Elfertified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm -Name: —��� 4AeJe "saa a-11 &�as Farm County: F-40
Owner Name: Rctrta/e 6e- le,_ s a A Phone No: _y��, S9� - 5 3 G
Mailing Address: _ 14'75 W, /Y) G
Facility Contact: Ronszld Pe 401s�_ Title: Phone No: ,q/l}- Sr7L 'TOGS`
OnsiteRepresentative: 2/ af74a Ale64s0 Integrator: sad y4�q
Certified Operator: Re P T P Operator Certification number:
Location of Farm:
M45wine ❑ Poultry ❑ Cattie ❑ Norse Latitude C a Longitude • • �K
Design Current
3winr L-a aory ro utanon
❑ 'A`ean to Feeder
ED °eder to Finish .2 Qi
❑ Farrow to '%kean
❑ Farroxv to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current Design Current
Poultry Capacity P01311111tiODCattle Ca acit`• Population
❑ Laver ❑ Dairy❑ Non Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area
Bolding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges 8 Stream Impacts
1, Is anv discharge observed from any part of the operation?
Discharge ori;inated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach 1A'ater of the State? (If ves, notify DWQ)
c. If discharge is observed- what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves- notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches)
05103101
Structure 5
❑ Yes D-90
❑ Yes 210
❑ Yes ED-No
❑ Yes ©'iQo
❑ Yes Lz}7vo
❑ Yes Eallo
❑ Yes 0410
Structure 6
Continued

Facility Number: g1 _I g Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑-No
22, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
El-N-6
23. Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
UNo
[IWaste Application ❑ Freeboard/ ❑ Waste Analysis"' ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
aNio
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q.AW
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
UTo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Q No
28. Does facility require a follow-up visit by same agency?
❑ Yes
E -No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
9Yes
❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑'Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
QN6
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
PNo
34. Did the facility fail to calibrate waste application equipment?
[:I Yes
35. Does record keeping for NPDES required forms need im-
provement? If yes, check the appropriate box below. El❑..Al Yes o
ElStocking Fort❑ Crop Yield Form ❑ Rainfall" ❑ Inspection After 1" Raines
❑ 120 Minute Inspections E] Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-#" 23 �i?�. Pe l erso n S �a
(r'eoy 'MaN'O 44ve i4e Sn.`� soap%s rcPor�s. Mr. Ilelerso,,7 ca,7
02�a1'4 f 4e /'ePe,4s "en needecl, /f1r. P� �P,so„ ✓ S /o e»r�, `y9 ]�a
take
R S o. I Sp mPI� S DOS,
41
3( Alr. loe e/`soar Aas a /'u%�ft6ea/ter 6wi-14 1101-1)5 /o
Week , He 3 la4c fie k�se%T Oe o.lr er saog5 arc Prese,, -
g aPP"'C:akno &✓eh14,
#3/-e I ersen r i P�Onrr'-r y �o ✓se 71-Ae /' ew N/-IOLrs Ace'"S
yeG,-
> drams
12112103

Facility Number:
Date of I uspection
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 46 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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceJimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen groupd ❑ Copper and/or Zinc
12. Cropf/ Y
tYPe
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 ❑.16
❑ Yes U.No
❑ Yes 04fo'
❑ Yes Q-Ko
❑ Yes 9-w
❑ Yes ❑"N—o
❑ Yes Q-No-
❑ Yes ❑-M
❑ Yes Q No
❑ Yes UNo
❑ Yes O No
❑ Yes 0-No
❑ Yes M-No
❑ Yes ❑ No
❑ Yes UNo
[3 Yes E],NO
❑ Yes UNo
Comn3ents (rt efer to gaesho>a I#) F.xplaw sisy YFS ans wens andfar any i�eeomnieataoas or any other couinie�nts=
:Use drawings of f e�iiy ir► better9rplarnM. sitnatz<ons: (ore tronaipag�s as wry) — }
.s Final Notes
- r [Field Copy ❑ Fi
M .L! I / f L 1 /
/pelerso, Aos cl c11,4,rnrlAG. dr4Ch I�cr,'f l4QI•r,Y Sro%I`� �-c� rrf I`;S
c✓��c,� ��/� Hof �n�aas fn �'',r. w��M �'.�/� ��,'�s �� .
Pe r elsOR
44
A&j 0 4ry;
�O
foci blase
e 4a/ S�pl S G/ G(�rrd
cJ.
rarrn if we// eP/
Reviewer/Inspector NameQ�
ReviewerAkspector Signature: Date: -O
12112103 Continued

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3
Date ofVisit: 'a'D Time: :3
Not Operational 0 Below Threshold
M Permitted © certified0Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Ppnall �Gr County: _5Cl ASOn _
Owner Name: _ —arlati ,,y�,�i0Le� rsoi, �^` % _��% Phone No: t0 — S 1a(per o
MailingAddress: ��S W /��_ i'li�aCt i !fUrn KC! --C /� � �G O�o_3
Facility Contact: Title:
Onsite Representative: KOno/d �e T�Cf�sO/n
Certified Operator: �nalQ loe -k- %SO ri
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: oa i0
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 u Longitude 0' 0` 0
;_- 'Design Current Design Carrent De
Swine.:Cs `acih 'Population Pouftry Cap actty '-Population,- • Cattle _ - Cii;
❑ Wean to Feeder
Feeder to Finish
1 .2 9 If
1 c9
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Neimbtr of Lagoons i ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdtitg Paods'/ 5altd Traps ❑ No Liquid Waste Management System __ r
Discharges & Stream lmnacts
1. Is any discharge observed from any part of the operation? ❑ Yes U No
Discharge originated at: ❑ Lagoon ❑ Sprav 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 ves, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
«'aste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 3 Structure b
ldentifier:
n
Freeboard (inches):
05103101 Continued

Facility Number. S — j
Date of Inspection `ATQ3
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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ®No
❑ Yes M No
❑ Yes � No
❑ Yes El No
❑ Yes 0 No
❑ Yes ®No
11. Is there evidence of over application? ❑ Excessive Pondmg ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®No
b) Does the facility need a wettable acre determination? ❑ Yes J4 No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
UQ No
I &
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[IQ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[RNo
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Camateats (refer tt►11105iid #j ExplauE say i'F,S sayers sad/pr;any, reedmmetttlations.Or say'ather ctsransents
Ilse drat*i s of faeil to better ezplatn st#natioas. (tree addttsanal pages as aeeessary) ❑ Field Copv ❑ Final Notes Za
E,
m. p
Ak
Reviewer/Inspector Name 1?` iC'�. r
Reviewer/Inspector Signature: Date:'r-03
05103101 U Continued

it
Type of Visit 4D Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facilih• Number Date of VisitTime:
rO Not Operational 0 Below Threshold
® Permitted M Certified ©Conditionally Certified [3RegisteredDate Last Operated or Above Threshold:
Farm Name: ' p '1.14 `K-_d'.)/ 7 County:
OwnerNamc: ___71Cd/+%A_/� 9� z_'A1 Phone No:
Mailing Address: �7 7 %� ��( �u �C� 'AC° ���✓f��i C /�����J
Facility Contact: a�✓��U �'� Title: Phone No:
Onsite Representative: "�-���d� Integrator:
Certified Operator: zge�'o_) Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse latitude 0' 06 u Longitude 0a ° 0"
_ Design Currents Designs Current y° a. Destgn Current
lnlatton-
Swine, Ca acity'°.Po Poultry - Ca achy Po 1tilation Cattles Ca acK P,o nlation
❑ Wean to Feeder
❑ La er
❑ Da'
Feeder to Finish
2 D
❑Non -La er
❑ Non -Dairy
❑ Farrow to Weanfanne-
❑ Farrow to Feeder
❑Othery '
Total Design-Capactty�`
❑ Farrow to Finish
_ g
❑ Gilts
_ - Total SSL i0
r
El Boars Boars
a o
umons ❑Subsurface Drains Present ❑ La oon Area ❑ S rav Field Area
-
13oltlin Tra s� � ❑ No Liquid Waste Management System ;
g fifid
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches):
05103101
Structure 5
❑ Yes ,® No
❑ Yes E] No
❑ Yes 150 No
❑ Yes ;KNo
❑ Yes eM No
❑ Yes No
❑ Yes FNo
Structure 6
Continued

Facility Number: gZ
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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type lwe"�W-4 . 1/ 9.PN/.c% . G 1
❑ Yes W No
❑ Yes �91 No
❑ Yes P1 No
❑ Yes RRNo
❑Yes PNo
El Yes >@No
❑ Yes /K1 No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes (Z:1 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
LIN No
b) Does the facility need a wettable acre determination?
❑ Yes
P9 No
c) This facility is pended for a wettable acre determination?
❑ Yes
91 No
15.
Does the receiving crop need improvement?
❑ Yes
JZ1 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,® No
Reqgired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
AS No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
El Yes
� No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
El No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑
O
(ie/ discharge, freeboard problems, over application)
Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
El No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
QNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refeto question #] Explatn any YES answers and/or any recommendations or aey outer rnmments.;
3� �a1 , t s�ea:.��+aL
Ug di Wifigs afi ii:ili tu'better explarni situations. {nse additional pages,as necessa ry)"
.++Its ���lli ti4� •�' ❑Field COPY ❑Final Notes
Reviewer/Inspector Name _
Reviewer/Inspector Signature: Date: Z z/ e L
05103101 Continued

Facility Number: — )gr Date of Inspection
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located new the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
© Yes ❑ No
❑ Yes ,® No
❑ Yes 91 No
❑ Yes ,❑ No
❑ Yes x❑ No
❑ Yes 91 No
Yes ❑ No
05103101

.. Ab
Type of Vislt 2" Compliance Inspection O Operation review O Lagoon Evaluation
Reason for Via€t 0 Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number a Date of Visit: %4 01 Time: a
O Not Operational Below Threshold
Permitted [I Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ... ._ ........
Farm Name: ».....(r,:' ....�I..., i� ............_ _.. County:.........*
Owner Name:
....f 4. . .... ............ ............ .r....... ................................. Phone No:....................... ........».................. ......... :.
Facility Contact: ...........�.•..o ...... f...e. ........ Title: ........Oua.A R. .................................. Phone No:........ »....... _. .
Mailing Address:
Onsite Representative: �..... hw� ........................................ Integrator: .......... P ._e...................... ........ ............. ....
Certified Operator:......._._ ............. � Vie. ).....„........... Operator Certification Number:_A"_ _ ..,_.._. ......... lam._-------
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' ��� Longitude �•
�° �«
Design Current ' :. Design Current Design Current
Ca, ci .Po ulatiou Poultry Ca` ct .,Po elation Cattle _ Ca
d ' .•Po
Wean to Feeder 10 Layer 10Dairy
-
Feeder to Finish ❑ Non -Layer I 1 10 Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
-
❑ Farrow to Finish Total Des' C'a
❑ Gilts . . ..ci.
Boars ToW Sstw
Nrimher of Lagoaa9 t C� Subsurface Drains Present [.agoon Area ❑ Spray Field Area _
.. .;
H6ldiCwP6b&_4_So1J& Traps t ❑ No Liquid Waste Management System
Diseharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes MNo
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 tNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JANo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes (9(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier.............................................................................................................................................
Freeboard (inches): 35
5/00
Continued on back

s
Facility Number: ( — Date of Inspection Ol
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes OfNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes jp No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
Up No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[a No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[XNo
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
NrNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
y No
12. Crop type trm n� � , . G rxr ?,. O S cyn W i►er># "&i.,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
%No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended fora wettable acre determination?
❑ Yes
❑ No
15, Does the receiving crop need improvement?
❑ Yes
[3 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
Off No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
19 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
JA No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
0 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[O No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [g No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes M'No
Rio yiolatigtis'e dgfcpepct vv re pQte(i llH"i;!g thjs'vp.. •Yoh wiii•><ec*�. ..o . . .
....
ori-es deiv& abi6f this visit: ... .
ar-reS' I'
D� i Cr�3X;an dcsi`�n
ReviewerAnspector Name n
Reviewer/Inspector Signature: Date: j6 c 5100

U
Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ( No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
tio-omments an or: rnwings:— - - - ��_ ,.� i
A61
5100

Division of Water Quality
Q Division of Soiland Water:Canservatron
- _ -
m Other _
Type of Visit 6compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number oate of Visit:
Permitted Wertified ❑ Conditionally Certified 0 Registered
Farm Name: ............. 'I.Cf ! ....... .. ...�................................
Owner Name:........
Time: �� Printed on: 7/21/2000
Q Not O erational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: -
............................................... Phone No:.....
Facility Contact: .................. Title:.,............... .. Phone No:
MailingAddress:................................................................................................................................................................... ..........................
Onsite Representative :....!1�?f;' f�r�.1-4,
........ ...... ............................... Integrator:......
/.................................
Certified Operator:...---...-ik�Z.4s.'1 ................r ...... ... ..v7+................... Operator Certification Number:... �?........
Location of Farm:
FN
0 Swine ❑ Poultry []Cattle ❑ Horse Latitude • 0` 14 Longitude �• �6 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I I ❑ Dairy
Feeder to Finish ❑Non -Layer J3 Non -Dairy
FarroW to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons f I I❑ Subsurface Drains Present_11❑ Lag—n Area I
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Diseharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the Conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. II• discharge is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
Spray Field Area
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes i2 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4
❑ Yes k No
Structure 5 Structure 6
Identifier: .............................................
Freeboard (inches): y3
5/00
Continued on back

Ll� Facility Numbcr:4R-Z — l Ej3 llutc cat' Inspection I Printed on: 7/21/2000
(� 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �Pg No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
Q5No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
/X No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
5LNo
Application
_Waste
10. Are there any buffers that need maintenance/improvement?
❑ Yes]
No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydrau1' Overload
❑ Yes
� No
12. Crop type iWais �_e
13. Do the receiving crops differ with those designated n the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
QNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement'?
❑ Yes
*!�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[9 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
J] No
Oe/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable sethack criteria in effect at the time of design?
❑ Yes.
Q No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
El No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
f&lo
24, Does facility require a follow-up visit by same agency'?
❑ Yes
ESLNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
6F;:l No
0: o yiolaiioOs_ 'o' i•• &ficie.ncies - sere nafed- &Wirtg {his visit: - Y66 will •eeeeive Rio futther.
.. correspondeirce: ahi f this :visit.: • ...:::....:::: ......:.:... .
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): _
4S ds C"� Ca_c�q 5 t I { (�
P.r slJ4Xe: "� 1 � prj 'A'-_ll�%Sl� C y`ak VC. e-3 &—et - �1n C..�c.Ic *_k
u
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ �� Date: / U`

Facility Number. — j Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 14 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1 " No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Yes ( No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes j� No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes hNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

O Routine O Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review AlbOther
Facility Number Date of Inspection FT7zz
Time of Inspection E:� 24 hr. (hh:mm)
$M Permitted [3 Certified Q Conditionally Certified 0 Registered 113 Not Operational Date Last Operated:
Farm Name: .........L 1�y� ....... �....�;.;e.......... :—........... County: ....... 5'!'�^rPs�.'�.............................................
Owner Name:.........' . Phone No: �,s!� sZ —
FacilityContact........................................./..................................... Title: .............../........�. ..................../... Phone No: ...................................................
`sailing Address: 1 � ..............................................I ..............
...........
Onsite Representative: .............................. Integrator:................
Certified Opera tor: ,,.,,,��.......��C.......................... Operator Certification Number: ..........................................
Location of Farm:
.........................................................•---.------........................................................._.----....................................................................................................................................... ►;
Latitude �•�� �•� Longitude �• ��=
Designf rrent ,` Design' CuireQt Design Current
Swine ;Ca i�ctty Fo elation Poultry Ca achy Population Cattle wxCa achy. Po ulafion
❑ Wean to Feeder ❑ Layer In Dairy
Feeder to Finish 9yo ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder - ❑ Other I IN;
❑ Farrow to Finish
El Gilts Total Design Capacity`'
a
❑ soars Total 5 W �
Number of I:agoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Fonds/ Sohd Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge ariainated at: ❑Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
.Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes &No
❑ Yes �6-No
❑ Yes KNo
❑ Yes JJ No
❑ Yes ONO
[]Yes M-No
Yes ❑ No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ........... / lt............................................... .................................... .............................. ..... ........................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes )g—No
�Lab�iG�- if�(�i /ate os 2�2///� seepage, etc.)
3/_o 3/99 Continued an back

0 Division of Soil and=Water Eonservabon-_OperaiiomReview x
f [3Division of Soil and Water Coaseri+atron ;Com] pliance lRspectton
:� Division of Water Qualaty_Comphance Inspection }
Agency. Operation
;Review
IO Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 2 •Date of Inspection /O
.,�.. Time of Inspection gs.3a 124 hr. (hh:mm)
M Permitted [3 Certified [3 Conditionally Certified [j Registered JE3 Not O erational Date Last Operated:
Farm Name: ko'e t ....... 94........ County: .......... 5—.Ven7a e.......................................
Owner Name: ....... 176047-fc�........ R:.... T,=Jesv d.............................. I...... Phone No: (0./.../6).. ............
2`%
.................................
Facility Contact: ........ me",, vw—/ s�... Title :......................................... .............. Phone No:
Mailing Address: ......11....7r.... V±.... ��' V..! � '°p�. ��'3 �... /..'.!✓9`� ..�V .. ��.... o?8W..................................
Onsite Representative:....1C rn/A!0 ..J..... , QS�.................................. Integrator:..... �...,F � �y ...F.�t`.PI[ ...........
Certified Operator: A / JsySDA.? Operator Certification Number :.........................................
P ..................��.-.... X.......................................
Location of Farm:
........................................................................................................................................................................................................................................................... .............. T
Latitude • ` i Longitude 0 4 �4
Design Current = Design Current Design Current _
Swine Capacity Po ulahon Poi 1t ry Capacrty Population Capacity Population _
Cattle
❑ Wean to Feedei
Feeder to Finish
z y22U
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance than -made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Il• yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Identifier:
4
Freeboard (inches):...........
........I. ...............
Structure 2 Structure 3 Structure d Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes X No-
❑ Yes XNo
❑ Yes XNo
❑ Yes N No
❑ Yes Wo
❑ Yes ❑ No
❑ Yes PjrNo
Structure 6
..... ...................................
❑ Yes 10 No
Continued on back

Facility Number: OZ — Date of Inspection
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding [I PAN
12. Crop type r6QAJ / 461ZA-10// , _e, ._4111 '_.►ie•l ^3
13. Do the receiving crops differ with those designated in the 6ertified Animal Waste Management Plan (CAWMP)?
14_ a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records"& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21- Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�: Rio yiolafigtis:or de#it ieQc3es ►vere pgted 0iWifig this:visit: Y:oir :wiII•ti-eceiye triti iurthetr •:
.•.�corresnnnr�eitce_a�mitthisvisit..-.-.•.•.•.•.-.-.-:•.-�-.-���• �.�.���.�•.-.�_•.•.-:-_•.•.-_•_•_•.. .•.
❑ Yes NNo
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes X No
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes D4 No
❑ Yes IR No
❑ Yes kNo
❑ Yes • Wo
❑ Yes A No
❑ Yes eKNo
❑ Yes 'Ilk No
❑ Yes .K No
❑ Yes KNo
❑ Yes ® No
❑ Yes ?"o
❑ Yes �No
❑ Yes �16o
3/23/99

Facility Number: Z -- 3 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 56 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27_ Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P(No
28. is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes qNo
roads, building structure, and/or public property) (
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 1KN0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes( No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? xYes ❑ No
3/23/99

HIGH FREEBOARD NOTIFICATION
DA E/ilt`, E
DWO Contact % �
Nome of Person
contacting DWa- Telephone No.(_)
FARM Name // �-✓.� �o � ��
County
Facility No.
Freeboard level of the Lagoon: ,17
Conditions cf the spray fields: el k _
NA2RATiVE: @nclude any instructions given to the farmer at the time of the call)
(A copy of each notification should be forwarded to the "GAFD BOX' in John Hostys office
as soon as possible)
Y

HIGH FREEBOARD NOTIFICATION
DAMM"E
Dwa contact /n
Name of Person
contacting DW c�a��� ' ' '`� Telephone No.(
FARM Name ✓,��,�/,c�.c:Y�,'az�
County
Facility No. 2� �J`���c�- 27
Freeboard level of the Lagoon:
Conditions of the spray fields:
NARiZATkVE: (Include any instructions given to the former at the time of the call)
(A copy of each notification should be forwarded to the 'GAFO BOX' in John Hasty's office
as soon as possible)

HIGH FREEBOARD NOTIFICATION
DAMMME
r\VQ Contact ,dad s
Name of Person /
concocting i7WGZ, afO� syy Telephone No.(___)
FARM Name
Goynty
Paciiity No. L L2 f g 3 .
freeboard level of the Lagoon; L`•
Conditions of the spray fields: . D &
NARRATIVE: (Include any instructions given to the former at the time of the call)
(A copy of each notification should be forworded to the "GAFO BOX' in John Hasty's office
as soon as possible)
t
i

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
November 25, 1998
George Ronald Peterson
Ronald Peterson and Sons 1-4
1475 W. Mt. Gilead Church Rd
Clinton NC 28328
Dear George Ronald Peterson:
A ��
NCDENR
NORTH CAROLINA DEPARTMENT Oh
ENVtRONMEN7 AND NATUF2P1 l V E D
11-1 0 1 1995
Subject: Application No. 82-0193
Additional Information RequRAYETTEVILLE
Ronald Peterson and Sons 1-4 REG. OFFICE
Animal Waste Operation
Sampson County
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject
application. Additional information is required before we can continue our review. Please address and submit
the following information by January 4, 1999: ,
1. Application window is missing for the wheat crop on Table 1 of your waste utilization plan.
2. Your waste utilization plan is written for a two-year rotation (except for Tract 6213 Fields 3A and
12). Hence, the total plant available nitrogen (PAN) listed on the summary table (page 5 and 6) is
added for both years. That resulted in a huge deficit when those numbers were compared with one
year PAN production. Please revise the summary table to show PAN deficit on an annual basis or
include two separate tables showing PAN utilization for both years of plan based on a two-year
rotation.
Please note that all revisions or amendments made to the waste utilization plan (WUP) or a
portion thereof are required to be signed and dated by both the landowner and the Technical
Specialist before they are submitted for review.
Please reference the subject permit application number when providing the requested information. All
information should be signed, sealed, and submitted in duplicate to my attention at the address below. The
information requested by this letter must be submitted on or before January 4, 1999 or the Division will return
your application as incomplete in accordance with 15A N.C.A.C. 2H .0200 and your facility will be considered to
be operating without a permit.
Please. be advised that operation of the subject animal waste management system without a valid permit is
a violation of North Carolina General Statute 143-215.1 and will subject you to the enforcement authority of the
Environmental Management Commission.
If you have any questions regarding this request, please call me at [phone], extension 363.
Sincerely,
JR Jos i
Non -Discharge Permitting Unit
cc: Fayetteville Regional Office, Water Quality
Permit File
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

04
Division of Soil and Water Conservation E3 Other Agency =��
Division of Water Quality`,.
1 fil
0 Routine 0 Complaint O Follow-up of DWQ inspection 0 follow-up of DSWC review 0 Other
Date of Inspection
Facility Number Time of Inspection 24 hr. (hh:mm)
E3 Registered X Certified 13 Applied for Permit © Permitted © Not Operational Date Last Opperrated:......._
Farm Name:.......... ..._ �...... e7`CrSo! Rr Countv:.........- / .. lTl..! ................ "I...........----.....
...
Owner Name:......... oe°r�e........ � .i................. Phone Vo. g�D ...��,�. ...��_..............
/� �/_ ..........................I.... .....
Facility Contact: ........C2&.11...... 11.T..7r' ................ Title:................................................................ Phone No: .....
Mailing Address: �G o ( ! r �{ 4r1.�I2I.,P!I. r�G ..........8
.............. .....C.�a................. f1C ....................... }........................... `
.................... .... ® f } �'
Onsitc Representative:..............U/t. /K.................... ............1...{. ... . Integrator:.... .......... S..... (�'!✓y.............
rSmr't
Certified Operator,...-... ,'...... C r...... ....... ------ !'- T'C ............... Operator Certification Number .........................................
Location of Farm:
Latitude 0 6 « Longitude �' �` �"
Design' aGurrent' �., llesign ° ,Current
Capacittv`.11PoPulafi�on -, Poultry .. 'CapacitvRopulation .:.Cattlex,,
❑ Wean to Feeder
q
❑ Layer
`
.ter
Feeder to Finish
v1 a
❑ Non -Layer
R„
Farrow to Wean
❑ Farrow to Feeder
❑Other
"
❑ Farrow to Finish
ToUil Dent
Gilts
R
7
❑ Boars
;n Capacity a i f
ntal'�CCi W'h: ��
General
1.
Are there any buffers that need maintenance/improvernent?
❑ Yes
XNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
I No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow.in gallmin?
A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Ai No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
P4 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ONo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
[f No
maintenance/improvement?
facility
KNo
6.
Is not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
A
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures Lagoonsjjolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes 0 No
❑ Yes XrNo
Structure 5 Structure 6
Identifier:
Freeboard(ft). ........... t.................. .................................... ................................... ........
10.
Is seepage observed from any of the structures?
❑ Yes
P� No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
XNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes
A No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
0 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
INNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) , ,j „
15.
Crop type S.SP'I f..... CA'?� �-�.......40 7(..................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
' l�No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
JVNo
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
Jim No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
22.
Does record keeping need improvement?
❑ Yes
JgNo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0-No:violations•ordefcieincies'were-noted-duringthis.visit.-Nou:willeeceive•no tirther:
correspundehbc about this: visit:
tl•J
Reviewer/inspector Name
Reviewer/Inspector Signature: — 4�z� Date: 9 —Y'/ ,&-

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
MYRoutine O Complaint O Foll(i%s-up of I)«'O inspection O Other l
Facility Number Date of Inspection I lQ,g-971
ARegistered
Tithe of Inspection ' 3d 24 hr. (hh:mm)
13 Certified © Applied for Permit [3 Permitted 0 Not O erational Date Last Operated:.............Farm Nante:.gQD e..Me.r3 .l._. .rIYL County• ... ......................................................................
/_1. ...............................................
Ow ncr Narrte:.. i� pr? e....LC Sa� Phone Flo...�1.J..�..3(a..l...............................................
/�
Facility Contact:.(_ rye..j ��.�'^'.................. Title:.L1.'�✓ Per Phone No:...................................................
Mailing Address:........ jr....W.:....i!'.tT�..L .r..�s +R.. Gs ..1.1f�: �.�.� 14 ... Nor . ...................... ..........................
Onsite Representative: ...D-�^ �...Integrator: ...tPT.e'....... ............................
Certified Operator;............................................................................................................... Operator Certification Number...................... .
Location of Farm.
..r►.............!�......P?... ... .....>M.. g.... ........................
07.... ..................................................................................................................................
Latitude a =` « Longitude • 6 64
y Design r r `. Design Current �s r Design Curremt
�Cnrrent „
Swmez �' Capacity Population Poultry CapacityPopulation� Cattle; Capacity -Population
❑Wean to Feeder
... r
Finish
to Wean
❑Farrow to Feeder
` ❑Farrow to
Gilts
El Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field [I Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface. Water? (If yes, notify, DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon tiystem'! (if yes, notify DWQ)
3. Is there evidence'of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
5_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ Na
❑ Yes �No
El Yes �No
❑ Yes �I ]�'o
❑ Yes No
❑ Yes No
Continued oar back
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field [I Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface. Water? (If yes, notify, DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon tiystem'! (if yes, notify DWQ)
3. Is there evidence'of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
5_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ Na
❑ Yes �No
El Yes �No
❑ Yes �I ]�'o
❑ Yes No
❑ Yes No
Continued oar back

Facility Number: f2_— /
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,tiolding fonds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
�
Freebnard (ft):. 2 /q..
10. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 7 ] No
❑ Yes,#No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff enterin waters of the State, notify DWQ)
QQ
15. Crop type ......... Llit—E.—i'>f.!.................�.G?!~`................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
I8. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewrinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.vitilations•or dericiencie's were nt tted-during this.visit.-.You:will ieceive.no fti tlier,:
Ofnr spoudence about this',visit " :
rod
_10t r� C"P.
❑ Yes /dNo
❑ Yes *0
❑ Yes #No
❑ Yes �No
❑ Yes 10
❑ Yes ❑ No
❑ Yes ANo
❑ Yes ANo
❑ Yes ''No
❑ Yes gNo
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
7/25197
Reviewer/Inspector Name D aw
SVI Jr
Reviewer/Inspector Signature: 0 14LX, Date: ��'

Facility Number: ga- -1� a
Division of Environmental Management
Anima_ 1 Feedlot Operations Site Visitation Record
�j Date:
Time:
General Information:
Farm Name:_county:
Owner Name: r,r• �� l�� d.n Phone No: 5" 2-5-3 6
L
On Site Representative: �-�a _ Integrator:
Mailing Address: 1 5-- 1n%•_ At !" d C4 v r C4 9 -(. a
Physical
Latitude:�I Longitude: I I
OneratiQn Description: (based on design characteristics)
Type of swine No. of Animals Type of Poultry No. of Animals Type of Cattle
No. of Animals
E] Sow ❑ Layer ❑ Dairy
0 Nursery ❑ Non -Layer ❑ Beef
❑ Feeder r�
OtherTjpe of Livestock Number of Animals:
Number of Lagoons: ---- (include in the Drawings and Observations the freeboard of each lagoon)
2�
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1-foot + 25 year 24 hour storm storage?:
Yes ❑
No @J
Is seepage observed from the lagoon?:
Yes ❑
No Ur --
Is erosion observed?:
Yes ❑
Node
Is any discharge observed?
Yes ❑
No �-
❑ Man-made ❑ Not Man-made
Cover Crop
-Does the facility need more acreage for spraying?:
Yes ❑
No Ctr�
Does the cover crop need improvement?:
Yes ❑
No ❑--
( list the crops which ne d improvement}
-
Crop type: ' Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes ❑
No ❑--
Is a well located within 100 feet of waste application?
Yes ❑
tNo ❑--
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
No a --
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
:'.No
AOI — January 17,1996

G, h1l
Maintenance
Does the facility maintenance need improvement? Yes ❑ No paw
Is there evidence of past discharge from any part of the operation? Yes ❑ No G-`
Does record Keeping need improvement? Yes ❑ No ❑�—'
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No
Explain any Yes answers:
cc: Facility Assessment Un 1 v
prawings or Observations:
a
AOI — January 17,19%
I--
n
Date:
Use Attachments if Needed