820199_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

[Type of Visit: LtyCom licence inspection U Operation Keview U Structure Evaluation(> "Technical Assistance
Reason for Visit: rutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r Departure Time: County: AI'L4 Region`
Farm Name: j,t +a� (�►ts� yr Owner Email:
Owner Name: > I��n 0 �T<I A . � Phone:
Mailing Address:
Physical Address:
Facility Contact: 6'r.4`'t-
V vt Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: �i' �y�
Certification Number: + `� �5 y
Certification Number:
Longitude:
Design
Cn_rrent
Design
Cut�rent
Design Current
Swine
Capacity
+Pop.
Wet Poultry
Capacity
Pop. I
@attle Capacity Pap.
Wean to Finish
I er
DairyCow
Wean to Feeder
Nan -La er
I
Dairy Calf
Feeder to Finish
.2-17' )
q '
_
Dairy Heifer
Farrow to Wean
,<'.
Dry Cow
Farrow to Feeder
©, P,oul Ca aci;1'0 .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
q Others t
�ti'
Turke Poults
Other
Other
4
Discharges and Stream Imnaets
1. Is any discharge observed from any part of the operation?
❑ Yes
E]aN6'__[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Q"I]A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
0 Yes
❑ No
0'NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[:j No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

[Facility Number: jDate of Inspection-7:
Waste Collection & Treatment
4.'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L_I N ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No Y _ _ ❑ 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 ka o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E]'_N o
❑ NA
❑ NE
S. 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?
I i . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fo ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window n ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0'6_ .'ice 5,60 C ` ,-t-
13_ Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
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?
IS. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑Yes o ❑NA ❑NE
❑ Yes�No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes [/] N ❑ NA ❑ NE
[:]Yes YNo ❑ NA ❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ef No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �jNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - q Date of inspection - 7 lam{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ©-Woo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes I_ -116 ❑ NA ❑ NE
the appropriate box(es) below.
1
❑ 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
[�-<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
��,.�
L7 o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�o
[] NA
[] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
L_1 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
B' ]-o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2 o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Oho
❑ NA
❑ NE
c ,( [7
Revi ewer/] nspector Name-
Reviewer/Inspector Signatut
Page 3 of 3
Phone: �Io-g33-333`
Date: �
2/4/2015

Type of Visit: Qf Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other l^0 Denied Access
Date of Visit: Arrival Time: Departure Time County: �r Region
Farm Name: le- A&I n , � AV Owner Email:
Owner Name: { Phone:
Mailing Address:
Physical Address:
Facility Contact: Cj (leTm Title:
Onsite Representative: ({
Certified Operator: I l
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
IF
Certification Number: / ! P(ell
Certification Number:
Longitude:
Design Current
Design Curt Design
Current
Seine
Ca MOP
p ty P
Wet Poult n Ca acPo * : Cattle Ca aci
rY I► h P P- tY
Po P.
Layer iry Cow
Wean to Finish
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
Dairy Heifcr
Farrow to Wean
Design "Current
Dry Cow
Farrow to Feeder
Dry I;o I I t lyl,Ca" aci P,o '
Non -Dairy
Farrow to Finish
Layers
s' .
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
IPUIlets Beef Brood Cr—,
Turkeys.
Other
Turkey Poults
s
l0ther:
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)?
d. Does the discharge bypass the waste management system? (Ifyes, 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?
Page 1 of 3
[::]Yes No [DNA ❑ NE
❑ Yes ❑ No � A 0 NE
❑ Yes El No FA ONE
0 Yes ❑ No NA ❑ NE
❑ Yes ❑ NA [] NE
ElYes No ❑ NA ❑ NE
21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes D-Nv—❑ NA ❑ NE
a. If yes, is waste level into the structural. freeboard? ❑ Yes ❑ No 3A ❑ 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
n-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
JEr-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
ETNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
6No
❑ 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
EJ'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E!rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): C B 44g.4 6.­E2� sG d Cw+ *'
13. Soil Type(s):
14. Do the receiving crops diner from those designated in the CAWMP? ❑ Yes [�rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes [ff No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E] o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Vo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �lo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes E3" o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 EfNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E f No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NNoo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C5No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
CIJ 6"� 40-1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A
C
❑ Yes E3 o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [IrNo ❑ NA ❑ NE
❑ Yes C f No ❑ NA ❑ NE
❑ Yes [1"'No
❑ Yes [] No
❑ Yes !-1 No
B-y',� 4S1
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
10 sl
Phone: `[t]3` 33
Date: qr417
21412015

61 nis 1I hAf,,_t f 6 ��
Type of Visit: JO'Comlpliznce Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ZRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: bj�D Arrival Tim Departure Time: �� County: rV{ Region
Farm Name: G' qL� Owner Email:
Owner Name: c. Phone:
Mailing Address:
Physical Address:
Facility Contact: -,..aj le'—3 Title: Phone:
Onsite Representative: tf i Integrator:
PL�n
Certified Operator: �C Certification Number: t T f Y
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design ,.Curren#
wai
Design Current
Pat,e
Swine
Capacity P,op.
Wet Poultry
Capacity
Capacity Pop.
Wean to Finish
[Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
''
Dairy Heifer
Farrow to Wean
Design"_ -Current
Dry Cow
Farrow to Feeder
Dr. P,oult .
Ca aci
Po :.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [5�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No LJJ�A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes []No EJNA ❑ 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 E3<o
❑ Yes [T''No
[/rliA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3
21412014 Continued

r
14 Id
lFacility Number: Date of Inspection: '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5-Ko-_
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[3-ITX
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard {in}:
w
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[21Gb
❑ 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
CjgKo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public Stealth or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
OKO
❑ NA
❑ NE
& Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CR o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
&'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IE!fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LDONo ❑ 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
Wiindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): %[(yj J'?i�r✓ C� -- C.�
13. Soil Type(s): a- _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes U No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes a o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes le;
❑ Yes L No
❑ Yes [�No
[-]Yes E No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other: le
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 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ['� o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: a- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? lA ' es �eo❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesErg'o ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes . [@,' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E O ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes F14o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[4<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
®No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E11N,o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Wo
❑ NA
❑ NE
NMI
p 1 _—
sf�� s� �,
p _3.(0 f2-�:7
Reviewer/Inspector Name
t lM
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412014

f ype of visit: gy7Routine
fiance inspection V Vperanon tceview V structure 1� vafuanon V recnmcat Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Ot) Departure Time:, C County: Region:
Farm Name: �� i'L� <S K S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 0 (,e? 04, V� � L��' Title: Phone:
Onsite Representative: ' C i Integrator: v_
4419
Certified Operator: Certification Number: q�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desigu Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Cnrrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
[Non -Layer
DairyCalf
Feeder to Finish
yi7
Design Current
D P,o Ca aci Flo
Layers
Non -Layers
DairyEEI Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ �o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E]rNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
�A
❑ NE
c. What is the estimated voiume 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
[Ej'<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [] N ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412014 CondAued

Facial Number: - Date of Inspection: ' u.t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3kN'6�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No WrNA ❑ 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 04,<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental rent, 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 EKo ❑ 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 io ❑ 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 EZ 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): W A,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E'l "o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FaN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ea"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ET No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[I/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 I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes Wy ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes rNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility. Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0:,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes l51vU ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
Q`No
❑ NA
❑ NE
❑ Yes
E]-<o
❑ NA
❑ NE
❑ Yes
E�- o
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes K 1"O ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
io
❑ NA
❑ NE
ENo
❑ NA
❑ NE
LJ 1�0
❑ NA
❑ NE
aoNo
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional Dazes as necessarv).
e-- 1�_-a
tf 4_1 f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P - qt 91
Phone: 3 3
Date:
21412014

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Ic
Date of Visit: t4rrival Time: 4 {o Departure Time: County: Region:
Farm Name: 1 4` Owner Email:
Owner Name: G Phone:
Mailing Address: LO
Physical Address:
Facility Contact: Coytjt� (JG-W74,,j-f Title:
Onsite Representative: I {
Certified Operator: l
L _V�r' tw
Back-up Operator:
Integrator:
Phone:
Pre;&Awl
Certification Number: 4 17
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Destgn Current
Swine Capacity Pop: WetI'oitltry Capacity�P_op
Design Current
CattleR Capacity Pop.
aiEZ Cow
Wean to Finish
La er
Wean to Feeder
n-La er
Dairy Calf
Dairy Heifer
D Cow
Feeder to Finish
Farrow to Wean
g, Des C�irrent..
Pool# . Ca ac� Po
La ers
Farrow to Feeder°l]
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Boars
Qther ,.,
Won -Lavers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ETKo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
DXA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
5<A'
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[fo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[2No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Fa=y Number: - Date of Ins ection: A3 fttogx
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3>o" ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[j;Xb-
❑ 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
ED,<
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
O No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[] o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Io
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E5"'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
❑ 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 �lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes [D'No ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [5-No ❑ NA ❑ NE
❑ Yes (D N-o ❑ 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 [B'IIo ❑ 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 Ej['No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I 1 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [I"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

04
Faci Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E] 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 E9-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ xu
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?
in
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[:]Yes [g No ❑ NA ❑ NE
❑ Yes [?I% o ❑ NA ❑ NE
❑ Yes [].M ❑ NA ❑ NE
❑ Yes Quo ❑ NA ❑ NE
❑ Yes P _ o
❑ Yes 9<0
V
❑ Yes E- ,
SA
Reviewer/Inspector Name: I C L
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: YS qq 3 3
Date: pC 3
21412011

Type of Visit: mpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 9_40utiue O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
IF me 4 111
Date of Visit: i Arrival Time: Departure Time: 0 ounty:,� ,- ik Region
Farm Name: C-1 0h4 '"K h„��F; 06^- Owner Email:
Owner Name: _ "T', vt Phone:
Mailing Address:
Physical Address:
Facility Contact: �� j�(,� J 'n. 1^ -4 _ Title: Phone:
Onsite Representative: Integrator:
C g �f rote
Certified Operator: Certification Number: Q'I
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current >; :: , ;�. Design Current Design Current
Swine Capacity Pop. Wet�Poultry Capacity' P,ap. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
La er
Dairy Cow
on -Layer
Dairy Calf
IDairyHeifer
ITT
D . Paul Ca aci Pla
Farrow to Wean
Farrow to Feeder
I Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
INon-La
ers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
-
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes 3-N`o (❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [] No 42-NA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No 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 EfNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes f'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E5"No [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number; - Date of Inspection
Waste i'glleetion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ER-<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
❑ 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
EH o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[;INc
❑ 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
[_' v
❑ NA
❑ NE
maintenance or improvement?
Waste AD lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [El<o ❑ NA
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ai
12. Crop Type(s):
❑ NE
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gj l�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E ' o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �To ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
w
[r]'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�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
FZ�- o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi Number: - Date of Ins ectio ' c--,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [(6l In ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] 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 LVo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []J'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 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? ❑ Yes E iYo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes �o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) -
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ff No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [55o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [] Yes [NI b ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 1Vo ❑ NA ❑ NE
Comments (refer. to question #}: Explain any YES answers and/or any ad ditiona[recommendations or any other comments;-.-'f
Use drawings of facility to better explain situations (use additional pages' as -necessary).
C'4 -c�4S
�c41�
Reviewer/Inspector Name: 1 Phone:��
Reviewer/Inspector Signature: Date7l ko .
Page 3 of 3 21412011

Qr
alb
Type of Visit: Q'hom ' nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:Departure Time: Coup -: Region
Farm Name: C I LIA12 TO01,r
Owner Name: is I�J 2t1r�
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (j Gk+159 Title: Phone:
Onsite Representative: (( Integrator: r G
Certified Operator: �� Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
DesignCurrent
nI esign Current
Swine
OF
Capacity Pop.
Wet Poultry
a «�hw
Capacity Pope
Cattle Capacity Pop.
La er
. _
Dairy Cow
Wean to Finish
Wean to Feeder
Non -La er
Dairy Calf
Da'Dai7y Heifer
Feeder to Finish
[40'
Farrow to Wean
Design renIt
Dry Cow
Farrow to Feeder
D , Foul
La ers
ea acr _ Po
Non-Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turkeys
Other
Turkey Pouets
Other
Other
Discharees and -Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E? I�TA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EJ A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Ufjo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
F]�<o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Inspection --I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): — f
Observed Freeboard (in):
5. Are there any immediate threats to e integrity of any of the structures observed?
❑ Yes
0
A ❑ 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
E 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 t reat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
o
A ❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FU,/o
A ❑ 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
V No
A ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
5 "o
A ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
L No
Ct ❑ 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
nn❑
12. Crop Type(s): &.­w4c - 57G Q
13. Soil Type(s): �-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes"
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FV<o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[—]Yes
[ja No
❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
1$_ Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [D'
❑ Yes Fallo
❑ Yes I No
❑ Yes Vo
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 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 o ❑ 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

Facifi Number: - Date of inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cpll o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C o ❑ NA ❑ NE
the appropriate box(es) below.
0 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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Rio ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L. jX'b ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
S-('.C7r �- t i__ l3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes L_4J'1"� ❑ NA ❑ NE
❑ Yes DY55 ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes
a io
❑ NA
❑ NE
❑ Yes
[U4o
❑ NA
❑ NE
[—]Yes
o ❑ NA ❑ NE
Phoned ?;-�
Date:
214120 l

(Type of Visit: (Compliance inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: ( "'Routine O Complaint Q Follow-up 0 Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: CO'S Departure Time: County:5Amq Sow
Farm Name: C \ Soo D . Owner Email:
Owner Name: GG `F_ {fir\Phone:
v
Mailing Address:
Physical Address:
Region: F
Facility Contact: C' 1 lv t\ h nn uy Title: Q,,,, RQ Phone:
Onsite Representative: GA Q C M �n(\Lf2 Integrator: pREa�F_
Certified Operator: V tF_n­, i) . ES Certification Number: %C(264y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current
Capacity. Pop.
Design Current
Wet Ponitry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Dairy Cow
on -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
-
Design Current
Dr Pooult , Ca aci P.o
Dairy Heifer
D Cow
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Other
Other
Non -Layers
Beef Feeder
Pullets
113eef Brood Cow
Turkeys
Turkey Poults
Other
Dischar es 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 E�No ❑ NA ❑ NE
[—]Yes [:]No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes [�No
❑ Yes [!No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page .1 of 3
21412011 Contdnned
0

Facili Number: - %ck JDate of Inspection: a6 Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2 o ❑ 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: 4`1
Spillway?:
Designed Freeboard (in): la
Observed Freeboard (in): �U
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 0 Yes [yNo ❑ 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 Cg"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [5 No ❑ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ev(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 dNo ❑ 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 ❑ EvidenceofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C • a~n f'�, j a Awy , G R oc L l ; ��1 :�' . C� ti ��, y i'� ��J;AE r- i'An ►L4L_
13. Soil Type(s): Lj (\�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 1JNo ❑ 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
[ tNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[v(No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[yNo
❑ 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 [2(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 g No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [g"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: - Date of Inspection: 4 .16/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
[2�No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[-]Yes
[]5*o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C�rNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[fNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�j No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[EfNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
YNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[v3 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[v-
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Cg"No
❑ NA
❑ NE
W E l
m Aana P"o
RZ� C(&AOS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9(Q -56%- &rs5l
Date: �4 U z
V412011

4
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Br1 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: n� Arrival Time: / D Departure Time: County:
Farm Name: i� �Yn rn 70 d Fit" Owner Email:
Owner Name: ^ ze yt yt a n a,j Phone:
Mailing Address:
Physical Address:
Facility Contact: ��rt�� �.�� Title: Phone:
Onsite Representative: Integrator:
Region:
Certified Operator. , 542=:� Certification Number: l 2 9 Y%
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current .Design . Current Design Current
Swine Capacity Pop. �4'ettlPoultryCapacity Pop. Cattle Capacity Pop.
�t
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Feeder to Finish 17
Non -La er
Dairy Calf
/�j/
'- s,
..µ Design Current
ci P}o
La ers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
UKNo
❑ 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
[ 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 I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA [] NE
❑ NA [] NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [& No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Callo
❑ 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
fV1 No
Ldmk
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�5 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
ENo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VLNo ❑ 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 WindDrift❑ Application Outside of Approved Area
12. Crop Type(s): ji�r"...�i'1 "'�`r 5 era(
13. Soil Type(s): Li 75 1 .fin
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 (a No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes jEa No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P4_No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ONE
Page 2 of 3 21412011 Condnsed

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo
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 gLNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes E,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 0 NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes 54'No ❑ NA ❑ NE
❑ Yes J4 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes allo
❑ 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: 33�
Date:/
21412011

i
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (! Routine 0 Complaint 0 Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visit:Q �O Arrival Time: JT Departure Time: I 41.'i9iff) County: �49
Region: _
40,
Farm Name: �~ _pflwn (/� �l fJH �S �GL�%IJ�S Owner Email:
Owner Name: %r L N P D 7 Tiix, s _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Zw v- 1, - Uy tl n Title: OaIA YI-- _ Phone No:
Onsite Representative: Integrator:
Certified Operator:—_, �'� Y Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' = " = Longitude: = ° = I = u
Swine
Design
Capacity
Current
Population Wet Poultry
Design Current
Capacity Population
I
Design Current
Cattle CapacityPopulation
❑ Dairy Cow
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
ID Layer
❑ Non -La er
Dry Poultry
I
1
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
Other
❑ Other
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: 9;Z—/ f
1
Date of Inspection /p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes [BNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZLNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )0 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 J,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fi4 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 0 Yes PLNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,0 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) A(" " „a+l/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CE[No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ER No ❑ NA ❑ NE
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 (2 No ❑ NA ❑ NE
Review•erlinspector Name I @ 57/�' 00 p--- Phone: 2?�2_'�63 JSCYO
Reviewer/Inspector Signature: Date:
Page 2 of 3 If_1iZ6rvR ..onrrnuea

Facility Number: — Date of Inspection /D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes BNo ❑ 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
BNo
❑ 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
tallo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tRNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
ES No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�g..No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of visit (O Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit E'Aoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: .Ot7 Departure Time: ; � County: Region:
//�'
Farm Name: 1o1If41yt d ) l522--rf-F42r" " Owner Email:
Owner Name: f's� n n 0 iT-,J1 �� _ _ Phone:
Mailing Address:
Physical Address: —�—
Facility Contact: ZY—JePft Y fi nos Title: Phone No:
Onsite Representative:.,. SE „: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = =6. Longitude: [= ° a A = .'
Design
Swine Capacity
Current
Population Wet Poultry
Design
Capacity
Current Design
Population Cattle Capacity
❑ Dairy Cow
Current
Population
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
1 10 Non-Layer-ANon-Layer—A
❑ Dairy Calf
❑ Dairy Heifer
EI_Dry Cow
El
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
VI Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
Farrow to Finish
❑ La ers
LaEl
❑ Gilts
❑ Non -Layers
❑ Boars
Other
[7 Other
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[9No
❑ 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
Qj 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?
12128104
Continued

Facility Number: — Date of Inspection
t
«'ante Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes. is waste level into the structural freeboard?
Structure I
Identifier:
Spillway?:
Designed Freeboard (in): f g
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
(:]Yes �RNo ❑ NA ❑ NE
❑Yes El No [I NA ❑NE
Structure 5 Structure 6
❑ Yes DeNo ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 19Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures 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 9-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No El NA ❑ NE
mamtenanmhimpYovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes j9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Chap Window [:]Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) 2�gt' /
13. Soil type(s) W p B
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ❑ Yes
L5�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
®.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
ilse drawings of facility to better explain situations. (use additional pages as necessary):
Cgs 71n It e- Wo
f �- '.� d ! t.�f Bit
41c ; u S 02,�G
in . B� ov!- Sirl F-drn-t a� �O �• .' -�
Reviewer/ins for
Pa Name
i-Y Phone: 4&0 y33 33aa
Reviewer/Inspector Signature:
Date: /y—
IZIZSIU4 Gontinued

Facility Number: Date of Inspection —�
IF
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EK No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ 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 0 Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EWNo
❑ 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
5� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
19No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
29zgo
❑ 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
&o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
FAN0
❑ NA
❑ NE
Comments and/or
12128104

Type of Visit (21.e6im- pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: I & Arrival Time: ; lf �79 Departure Time: (7 CountyRegion:
Farm Name: an ar,v-, Owner Email:
Owner Name: /qs' /to 4 Y1 _ •_ - C�] D --t5' S Phone:
Mailing Address:
Physical Address:
Facility Contact: 4;= Yet YL 0, � S Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No: -�l` &c4
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� ' ❑ « Longitude: = ° = I ❑
-NoDesign
Current . Designer Current
Design Current
Swine
Ca aci Po ulattonf . •-- Vet Poultry Capaci Po ulation
P h,P h a l? ..Y.
Cattle -' Ca aci Po ulation
P h P
❑ Layer
❑Dai Cow
E
❑ Non -Layer
❑Dai Calf
5" � �` ,
❑ DairyHeifer
- Dry Poultry _ _
-_-��
❑ Layers
❑Non -Layers
- ❑ Pullets
❑ D Cow
❑ Non -Dairy
❑Beef Stocker
❑ Beef Feeder
❑Beef Brood Co
_
.. ❑ Turkeys
Other
�` " "'� ❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
ean to Finishean
to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
Discharses &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
,® No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El 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?
El Yes
(3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[I Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/2$/04
Continued

Facility Number: Date of Inspection ly
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes JQ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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
M No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® 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
fA No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind ❑ Application Outside of Area
%Drift
12. Crop tyPe(s)1�-
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?
[Sd Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
yes
®.No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA ❑ NE
Comments (refer to question #j: 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]
'e
T
Reviewer/inspector Name Phone: Do
Reviewer/inspector Signature: Date: (j 0-1-12001>
Page 2 of 3 12128104 Continued

Facility Number: g — Date of Inspection -3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes I�.No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design g ❑ Maps p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ 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
Jallo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IS No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E9No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3No
❑ 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
D9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
DI No
❑ NA
❑ NE
Add►EionalCommen'tsandlor-DraWtngs.,.' M ��
Page 3 of 3 12128104

Q Division of Water Quality S'JZ
Facility Number Q Division of Soil and Water Conservation 7 30` 07
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: "T% Arrival Time: dO Departure Time: County: Region: ' K 0
Farm Name: cTL..,—n r��ij Il t'S Fa'em.`— Owner Email:
Owner Name: & L C=13 ►t �� J & tz Z-- i Phone:
Mailing Address:
Physical Address:
Facility Contact: ( p V O k,, r� ►l *e_5 Title: Phone No:
Onsite Representative: Sg�s Integrator: 0262"
Certified Operator: Save Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =O =t ❑ Longitude: =° =' E--1 "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischart=es & 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
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Pg No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
2,No
❑ NA
❑ NE
12128104 Continued

n
Facility Number: Q11
Date of Inspection 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes JR No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): %9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 10 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 A 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 RPRVEINA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P 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?
1 i _ 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Saqnj, I fist-e-"5nJ n,&J leark'
13. Soil type(s) Lu 4Z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JRNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes RNo ElNA ElNE
17. Does the facility lack adequate acreage for land application? ❑ Yes [S.No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes &No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7 W yr
Reviewer/Inspector Name _ j v Phone:
Reviewerllnspector Signature: Date: ;2-Z>�g T C-
I&Z&'V4 continued

r
Facility Number: — Date of Inspection LLB 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IM No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 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
EgNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Z 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
Z 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
JgNo
❑ 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
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J.No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ,Coompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit �,Koutine Q Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: V Departure Time: a County: Region:
Farm Name: r�L �N w_ 8 4 L-_ S Fe? s rase 5 Owner Email:
Owner Name: ,art n �e'� K r 4— Phone:
Mailing Address: 14;r-+x -f �G +`�"�- _ ll� �•
Physical Address: --�--
Facility Contact: _ r, L � n � U Bpnc 4 _ Title:
Onsite Representative: Saw `e-
Certified Operator: ,Sau-'r__
Back-up Operator:
Phone No:
Integrator: 42;"1*7 G
Operator Certification Number: $ 77
Back-up Certification Number:
Location of Farm: Latitude: = 0 = ❑As Longitude: = ° = 6 ❑ it
Design Current Design Current
Swine Capacity Popula#ion Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
to Finish ❑ Layer
❑ DairyCow
to Feeder
❑ Non -Layer
❑ DairyCalf
ER r to Finish O D/
Dry Poultry
❑ DairyHeifer
w to Wean
❑ D Cow
w to Feeder
El Non -Dairy
FFinish
w to Finish
❑ Layers
❑Non -La ers❑ Pullets
❑ Beef Stocker
❑Beef Feeder
❑Beef Brood Co❑
Turke s
❑ Turke Poul
Number of Structures:
❑Other
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
allo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
PqNo
❑ 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
OTNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�R No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: gEaT Date of Inspection lv
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [KVo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes WNo ❑ 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 K 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 g[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? X Yes []No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes 4 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 EZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EX No ❑ NA ❑ NE
maintenance/improvement?
1. 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 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)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ 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 EL No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
SNO
❑ NA
❑ NE
IComments (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):
La -61
Reviewer/Inspector Name fir/ p.� Phone: �% �.3'--3.300
Reviewer/Inspector Signature: Date: ly_/ �4_17120Z)6
rage Z uJ j 114114aivY %-Unisnuea

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

Type of Visit * Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: Time:
Q Not Operational C Below Threshold
G'�ermitted E3`ter ified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: .....__....................__ County:... 5�!non� ............. ...f-��......
..
Owner Name:- , ,cnE 5 Phone No: l. err C?
........
Mailing Address:.. �.�...��?�� L �rrie C %; � Tory N C 2,9.3 .,2 53
Facilitv Contact: ........ kkao........ _` c ?u ....... ...... _.... ..._ Title: ... ....... ..... ............................. ------ Phone No: _.y�0 w 590.:. g ��..
Onsite Representative: .................. Integrator: ,,,, r a La l f......._.........----
Certified Operator:._... � �.�art _-. Q...... rG ��� .. Operator Certification Number:... 122S.�.V
Location of Farm:
`5�wine ❑ Poultry [3Cattle [3Horse Latitude �• �4 �44 Longitude �• �4 �«
©
"_ Destgu Current = �KfffM Design Current Desrgn := Cru lent
Swine :zPoTulatron ._-Por�ttr3' .. ­��.-Ca : Po uiation -%OiRl�� act FPo nlahom.
Wean to Feeder ❑Layer ❑Dairy "7
eeder to Finish _< Non -Layer Non -Dairy
Farrow to Wean
�s
Farrow to Feeder Other
:..
Farrow to Finish ITo#al'Dest Ca
Gilts
Boars _ - .:Tot$1 SSLW
Nmmber of I. agoons
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 galJnvn'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier I
❑ Yes U>lo
❑ Yes B-No
[:]Yes g-N6
❑ Yes ❑-No
❑ Yes Q-No
❑ Yes ONO
❑ Yes Q No
Structure 6
Freeboard (inches): Ll I,/
12112103 Continued

Fackity Number: f2, - -
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes &�Ko_
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes 0
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 maintenancelimprovement? ❑ Yes U-No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes 0-?Co
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes M-Ko—
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 6s1Prfo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑-Ko
[]Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [:]Copper. and/or Zinc
12. Crop type &II- le, r^,:,4249Q C4 9'd2 J�A 7,4,z e, COCK)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes B-NT__
14. a) Does the facility lack adequate acreage for land application? ❑ Yes +[}#o
b) Does the facility need a wettable acre determination? ❑ Yes 944o
c) This facility is pended for a wettable acre determination? ❑ Yes E.No
15. Does the receiving crop need improvement? ❑ Yes 0-9o­
16. Is there a lack of adequate waste application equipment? ❑ Yes (t WO
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes sl; o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, []Yes 14-riT6
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 ❑ Yes [moo
Air Quality representative immediately-
Reviewer/Inspector Name ;
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: g-;? Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Owo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, desip, ma sue, etc.)
❑ Yes
Q_No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
03.No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Eg-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q No-
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
DNt5
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[moo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29- Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ED.No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
9-Ye-s
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑-ib
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
[}No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
[moo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑No
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit- You will receive no further correspondence about this visit_
12112103

Site Requires Immediate Attention: AO
Facility No. $_Z' I9g
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3W!) 13 ' 1995
Time: f (, 5 9
Farm Name/Owner: &IcnwN J or4e s / (3le vAt 3__ oe.s
Mailing Address: Ft, 3 Box 3Z7 C C.liw oor A/C Z$3Z$ -
County: 56 00�j
Integrator: e-s s T vc. Phone: l9/0,) 5 9 Z- 5 7 7 1
On Site Representative. _G_ I «nl U-Cae-S Phone: 6-91o2 5& - (nlr� 3Ca
Physical Address/Location: _
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 'Z` q-0 Number of Animals on Site: Z9iLO
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 35 ° o(P' 30" Longitude:78 ° Z3' 00"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (es or No
Was any seepage observed from the la oon(s)?
Is adequate land available fRpr spray? Ye or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin 9 Ye or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes of(g)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or N&
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or N ` If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: c '
R;c_K,i Re-ve.[s
Inspector Name
Actual Freeboard: '9 Ft. 0 Inches
Yes o N>DWas any erosion observed? Yes o>(s)
Is the cover crop adequate? Yes r No
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

//, - S 9
WMTH CAROLIA DEPARTMENT OF EMMOMOMT, HEALTH b NATURAL RESODRCiS
DMSION OF MMONHENTAL NAMAGEMM
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
.`..+«eve. _ ,� ": ':.:: •� ••.� -,,�_„Po.� - r ,:•i�C� r M: ..-�.�
.i�'� '',:-�wA•�';:Lw�•4�ir :*,:„v+,•:�: 1:-vr�=b;'.:�• - >`;.'i�::. r
° FARM .N]'►]�iOSiNF�t.5yI�ISPE{ItION
*iTE s - ; YARl�i _i+l[IIv f
(-i I n
MSAII.z3�NG.•�DR$^sS. #,�a���,,
'-.,'�°.,. Y�. �:."pSi.F.PfiOi�iE�� � '�,...:.
_ }:.�x
��
All questions answered negatively will be discussed in sufficient detail in
the-Com.ments Section to enable the deemed Permittee to perform the appropriate
corrections:
S=ON
Animal operation : �YltSh
Horses, cattle, wine poultry, or sheep
tggarON II
lip
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CF1tMITQ ANIMAL
WASTE MAKAGEMEW P}'.W,
S. noes this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
5. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

SEMON III
Field -Site Kanag2!gent
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25'ft. of a USGS Map
Slue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar scan -made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CPRT2FIQn0N?
7. Does animal waste lagoon have sufficient {O6f
freeboard? How much? (Approximately g )
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION TV
CgWents

Fill
M30
It
in 07 Al f
rip%

.1NMULL WAS= IGQGLG=0NT 21" CXRTZPIGITSOIT POR NEW OR =2A== PX7LOTS
Please rstu== the cleted fo= to the Division of HbrvirOamaatal 2laaasemant it
the add;esa oa the reverse Side of thia forte.
Name of fazes (Please rint) :
Address: A7'• 9a�, 32-7G
4 Phone No .: b; -`� — 66 al.
County: S+a 3351Sz I
a= location: Latitude and Longitude-W fa_ do ~/7a'� e � (re(rsired) . � also,
please attach a copy of a county road map with location identified.
Ty -pa of operation (swine, layer, dairy, etc.) : rlr
Design capacity (number of animals):
Average s4ze of operation'(12 month population avg.)- 2!246 -
Average acreage needed for land application of waste (acres) : .z3 •`
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Tecb=ical Specialist Cartifiaatio�s
As a technical specialist designated by the North Carolina Soil and Water
Conservacian Commission pursuant to 15A NCAC 6F .0005, i certify that the new or
expanded animal waste management system as installed for the Farm named above
has an animal waste management plan that meets the design, constriction,
operation and ma:i_-itenance standards and specifications of the Division of
=avironmenta.l Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to 15A NCAC 2H.0217 and
ISA NCAC 6F .0001-.0005. The following elements and their corresponding
criteria —have —been verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third parry): access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stor=water runoff events less severs than the 25-year, 24-hour
stors_
YAK of Tecbnieal Specialirt (P1cosQ Print)-: Z/a rn gig rV r.
Affiliation:
Address (Agency) : Phone No . sI3? - 17763
C'�[ IAM/V/ 1Vc. 3P3 2.?
Signature ) - Date: 6 — ��:��_
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Owns=/Hanager AQreemaat:
i (we) understand the operation and maintenance procedures established in the
approved anim-1 waste management plan for the fare named above and will implement
these procedures. 1 (we) know that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be suhmitted to the Division of
Emvirormental Management before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either trough a man-made conveyance or chrough
rtiroff from a storm event less severe than the 25-year, 24-hour storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Name of Land owner (Please Print) : (s- Z 2 N A/ Il a y "s , r1 o W 0-
Signature: /.yz� : , va==C_— Date --
Name of Xanager, if different from owner (Please print):
Signature: Date:
Wig: A change in land ownership requires nocification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Favironmen al Management within 60 days or a title transfer.
DEM USE ONLY : AC==e #

.��titlC.r t1i i`4QItit L'vitJm IU
DePcrtment of 'Environment,
Health and Natural Resources
Oivisicn et Bnvironmentcl Mcncgement
Janes B. Hunt, Jr., Governer
Jonathan E. Howes. Secr etcry
A. pr_S+Cn HO'rrui+�a. ii., r.L., Director
CM=!zTC&'rrCN Pa.- *iE'.d QR EY2A3`MED PL*TT L ;MEDLOT
MISTRUCT2ONS FOR C . T=E ATiCN OF.-APVRO'J•E*J ANI2�►.AL WASIME MMAGMf= PLANS =QR
YE—_W OR MCP UME:7 AIUMMAL WAS= MANAG22= SYS iMIEMS SZRV" VG 'LCTS
In order to be deemed perai.tted by the Di•7iSion of r.nviroruaental :Management
(=4) , the owner at any new or expanded ar:imal waste management system
consc-ructed after Januarl 1, 1994 which is designed to sezve greater than or
equal to the animal populations listed 'below is required to submit a signed
certification fora to OEM blfors the new animals are stocked on the faznn.
Pasture operations are exempt from the requirement to be certified.
100 head of cattle
75 h=ses
250 swizz -
1,000 sheep
30,000 bids wits a ].iqu3d waste system
The cartificatiors must be signed by the owner of the feedlot (and manager if
different from the owner) and by any technical specialist designated by the Soil
and waltz Cons erraCion Commission pursuant to ISA NCAC 6F .0001-.0005. A
technical specialist must verify by an on -site inspection that all applicable
design and construction standards and, specifications are met as installed and
w.�.0 41y appliZd Ie •sta idaxt's -and -s-p_cificat*ions can
be met. -
Although the actual number of animals at t':e facil•zty may vazy"f_dm�-time to,time,
tine design capacity of the waste handling system should'. be 'used to determine- if
a farm is subject to the certification requirement. For example, if the waste
system for a feedlot is designed to handle 300 hogs but the average population
wil1 be 200 hogs, then the waste management system requires a certification.
This certification is required by regulations governing aniz-al waste management
systems adopted by the Environmental Management Commisslon (EMC) on December 10,
1992 (Title 15A NCAC 2H .0217).
Cn the reverse side of this page is the certification _o= which must be
submitted to OEM before new animals are stocked on the fa-*-n. Assistance in
campleti ng t e for: can be obtained fzom one of the local agric=lturai agencies
surfh as the soil and waxer conservation. district, the USDA -Soil Conservation
Service, or the N.C. Cooperative Mxtensiorr Service. The fora should be sent to:
Degaztment of Environment, Healtlh and
Division of Enviz=.mental .'Management
Water Quality Section, Planning Branca
P.O. Box 29535
Raleigh. N.C. 27626-0535
Phone: [phone]
or= 10: AC_7�',v0194
,Natural' Resources'
, I IrX
Steve W. Tedder, Chief
Water Quality Section
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P.O. Box 295.35. Rdeich. North Ccrcrin i 27626-C6315 Teiechcne 9T9-733-7015 FAX [phone]
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