820201_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Review Q Structure Evaluation p Technical Assistance
up O Referral O Emereency O Other 0 Denied Access
Date of Visit: Arrival Time: /% cVD Departure Time: dr7 County: Region: j'?Z-0
Farm Name: ��Gr/�'� --c�'S Owner Email:
Owner Name:,.. J��diS�"`- Phone:
Mailing Address:
Physical Address:
Facility Contact: 04r-) _ �j r.iz�SC ,_ Title: Z)-w n r r" Phone:
Onsite Representative: S1_111__—
Certified Operator: 6 -e
Back-up Operator:
Location of Farm:
Latitude:
integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cable Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
I
lf
Feeder to Finish
Farrow to Wean
Design Current
I) . P,oul Ca aci P,o
La ers
Da Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Turke s
Turkey Poults
Other
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [,D< ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
go
❑ NA
❑ NE
[:]Yes
Lam o
❑ NA
❑ NE
Page I of 3 21412015 Continued

acifl Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]'V'es
[:]No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[31�o
❑ NA
[] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): j4
Observed Freeboard (in): G t5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�Noo
NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2-lGo
❑ 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
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ 'No
❑ NA
❑ NE
maintenance or improvement?
1 l . is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ 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): 1 of
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q f4o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E]"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 [El'No ❑ NA ❑ NE
[:]Yes []`No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes []'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�]rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EDINo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Vacility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0No
❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3No
❑ 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
[3 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
EfNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[] No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
0 Yes
E:rNo
❑ 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
El 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
Ej No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
6"No
❑ NA ❑ NE
3se,drawings ©f:fiicility to better ezplain)'situahons. (use, addihonal Pages as gecessary}: ;
,)L,&p W6•s
Reviewer/Inspector Name: Phone
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type or Visit: U Compliance Inspection U Operation Review Q) Structure Evaluation 0 Technical Assistance
Reason for Visit: GIZoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 'jam Departure Time: ; 3 a County: -s�2e v' --Region:
Farm Name: f �� o. S'p�a✓yvt� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: t -�� ✓S S '-� Title: eZ4,;n Phone:
Onsite Representative: �j� integrator:
Certified Operator: s �`�- Certification Number:�ps'
Back-up Operator:
Certification Number:
Location of Farm: latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop Cattle
Design Gurreot
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
DairyHeifer
Feeder to Finish
Design
D . �P,oal Ca aci .,
Current
- 1'0 .
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Turkeys
Turkey Pouets
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
2�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[-]Yes [:]No
❑ Yes No
❑ Yes [_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

r
l
' 1~ acili iNumber: - Date of Inspection:
Waste Collection & 'Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No
❑ NA
❑ NE
(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 [RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E, 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 IS -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [�JNo
❑ 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 C&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [F�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (Eg-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 allo ❑ NA ❑ NE
❑ Yes LB -No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes '2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo [] 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 l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes QkNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 214120I5 Continued

t Faelli _'Number: jDate of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo DNA ❑ 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 Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes rM 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 ® 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 R 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 jo No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? [:]Yes [allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EINo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes C&No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signatur
Page 3 of 3
Phone: c}/D — e?3: l l
Date: f�7 J—�i7Jz
21412015

'Division of Water Resources
Facility Number ®- Q2d Division of soil and Water Conservation
PpOther Agency
Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit;bt 11T Arrival Time: +; Departure Time: County: AmASo&j Region: _FQ
Farm Name: pQq rJo vi Fe, rM .S Owner Email:
Owner Name: SA_o vt regrie,n Phone:
Mailing Address:
Physical Address:
Facility Contact: -S-,;zS c, vt Pe,, r-to Title: Phone:
Onsite Representative: S e _ _ Integrator: f lrP,54x, e,
Certified Operator: SAM C Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wean to Feeder
Feeder to Finish %
Wet Poeiltry
I I Layer
I INon-Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
E
Layers
Ca aci
Po
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
nNon-Layers
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes &No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes
[]No
[:]Yes
dNo
❑ Yes
Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Faciti Number: - Qa. I Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 119`
Observed Freeboard (in): t),S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ONo ❑ 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 2No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E6o ❑ 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 03"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C10 ❑ NA ❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes �10 ❑ 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): Uef m Ud 4/ !q rn �gk hea.r .S
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Io
❑ 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
fo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[+"No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[✓]"'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ 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 [3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�lo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: f3Z - 02121 jDate of Ins a-dion: + — /-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ER<o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [gr<o
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 [v]'No
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3"No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortalityrates 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?
Reviewer/Inspector Name:y� t` (')t +e. w
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ Yes [O No [] NA ❑ NE
[:]Yes 02'f4o [DNA ❑ NE
❑ Yes �o ❑ NA ❑ NE
[:]Yes [ f"No ❑ NA ❑ NE
❑ Yes
B3 No
❑ Yes
UrNo
❑ Yes
Ea No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone:
Date:
21412015

k
Type of Visit: {-YC_omppliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0toutine O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: I- Arrival Time: f ( Departure Time: County:- � Region: �� D
Farm Name: D� i�.rs8� �ar Owner Email:
Owner Name: Sa� ��! fdrs oaf Phone:
Mailing Address:
Physical Address:
Facility Contact: a--- Title: AC4Jt4 Phone:
Onsite Representative: Integrator:
Certified Operator: 3' _ _ _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
;Current
Design
Current
Swine
Capacity Pop.
We.# Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Feeder to Finish
D
:.
airy Calf
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P.oullr
Ca aci .Po' .
Non -Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
L
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream ImD9ct5
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [] Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 S& No
[:]Yes Eallo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

FacW Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff.�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 13 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a -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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[S�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
0,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ej41Vo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JNo ❑ 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 Win/dowL ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): I_'O,-'L /.Uh,rJ k ire �'fylHcsR laz,-
i
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes I&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R]'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
O'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ 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 J0,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? ; [D Yes ONo [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;0 No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Ds ection:
4 /
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
�No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ENo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
�allo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
D Yes
allo
❑ 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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes C3.No ❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
[:]Yes [&No ❑ NA ❑ NE
[:]Yes
jS,'No
❑ NA
❑ NE
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
E�LNo
❑ NA
❑ NE
Comments (refe%to question#/] Explam agy YES -answers and/or any additional recommendations or anyxotherd mmentM
_. _.c _. '
drawings af`facili yto befier ezpl`a�n situations:{use additions[ pages as:necessary). Use draw
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:D 3300
Date:
21412014

s � �sZ 3I--'ti
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /fs ~f Arrival Time: .'aD Departure Time: jOc7 County: Region:
7 Farm Name: Owner Email:
Owner Name: ' cT-- -f Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: iFGyn �°� Phone:
Onsite Representative: f"­ Integrator: z!'� . _
Certified Operator: ��"'`� Certification Number:,Y
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet P0Wtry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
)4
Feeder to Finish 1, D 3 Dai Heifer
Farrow to Wean Design Current Cow
Farrow to Feeder D . P.oW Ca aci P.a Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets I 113cef Brood Cow
Turkeys
Other Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
IS No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
[]Yes
❑ No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
[] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Et] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�e No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: 9- i Date of Inspection: —%
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CNo
❑ 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
URLNo
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E&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
JR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ LNo ❑ 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): Gd /f'L l �Y= /Y�� L �ri�'ru2i/�r xpp&_/IE
13_ Soil Type(s): _)�Ill"q
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 rO No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JQ, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
0 Yes allo ❑ NA ❑ NE
❑ Yes E�'No ❑ NA 0 NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J;a 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 Cj§,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 Eg-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Eg-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - 110 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes .[ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [!�No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PS No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CaNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
Reviewer/inspector Name: ��,.� �� zy/s-� Phone: 9fQfY�a
Reviewer/inspector Signature: Date:
Page 3 of 3 21412014

- ivrsion of Water Quali
Facility NutabeDivision of Soil and Wa a Conservation /�-7�7 --►3
O Other Agency
Type of visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Cyl�outine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ' O Departure Time: :w County:
Farm Name_ ��, �Q/��.�_ 15;/'rc_ _ Owner Email:
Owner Name: �GtSB�-. �' j�ra�sp.�. Phone:
Mailing Address:
Physical Address:
Facility Contact: � P,_,5 Title: Phone:
Region: rtQ
Onsite Representative: Integrator:T /Ei�
Certified Operator: Certification Number: 4Za +04?3--
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swlne
Ca aci Po p•
WetPaultry
Capa ty
Cattle Capacity Pap.
_.T
ssPop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
9 D p
�=
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
sD ry, Poult ,
Ca�aciPo
P.
Non -Dairy
Farrow to Finish
ILayers.
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
__...
Turkeys
Other
_
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
S No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ 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
JZL No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - 2 ti _)_j jDate of Inspection: — /3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
t 25. Is the facility out of compliance with permit conditions related to sludge`? If yes, check ❑ Yes 3 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes [&No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C. No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 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 allo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ZNo ❑ 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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑' NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LK No
❑ NA
❑ NE
Use drawings offfa iGty tp better explain siWatiOns (use additional pages as necessary) y er„comments.
Comments (refer to uestion Ea lain an : YES. answers and/or an additional recommendations or an otli
. i
FUl" 5 T7 f�uJ SP C' D rr/rr!
lv u �. ��� �•`5 �"r"z,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: } 3
21412011

[Facility Number: jDate of Inspection:
— /3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
[] NE
•
a. If yes, is waste level into the structural freeboard?
[—]Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): t
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
[R 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
[RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[4 No
O NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s) t71 ![ IDr .3 ��r r /G 44t �,;'/" '
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Callo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
M 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. QLYcs 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 ® No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04opl�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : pa Departure Time: -O0 County: Region:
Farm Name_x-s, f�,��/`� raw �/�� Owner Email:
Owner Name:f' ��a/q-� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Ce loz Phone:
Onsite Representative: �S�L,� Integrator:
Certified Operator: Certification Number:�Q�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop. Wet Poultry
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
airy Calf
Wean to Finish
Layer
I INon-Layer
Wean to Feeder
Feeder to Finish
D P,onl
Design
Ca acit
Current
Pao
I
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
I 113eef Brood Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
Other
01 Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 RLNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [-]No
❑ Yes [&No
❑ Yes [a No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of ins ection:
Waste Collection & Treatment
4. [s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in): _ Z2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J&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 JQD4o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes �No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes V�F]Nlo
❑ 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 [a 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 J�4 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 Wind Drift ❑ Application Outside of ApprovedArea
�of
12. Crop TYpe(s): _.� /G>'/,� /S 4e�;
4in/
13. Soil Type(s): ND
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P;T-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JgNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Wo ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
JHNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
25 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E;,,No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists 0 Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZ,,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 P5.1;10 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jWo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
4 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes JE�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 J�a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes ZNo ❑NA ❑NE
❑ Yes "' No ❑ NA ❑ NE
❑ Yes IN -No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[] Yes jo No
[:]Yes allo
❑ Yes jig -No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
orits.
Comments (refer to question #): Explain ainy`YES m answers and/or any additional recomendations or,any)otlier com en
Use drawings of facility to better explain situi tion&(use,additional pages as necessary) .
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:33Q�
Date: %—�/J"
2/4/2011

Type of Visit: QKompliance Inspection n Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Q�<outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: rrM Arrival Time: Departure Time: County: Region;j'��
Farm Name: ow l�(�t/t'� Owner Email:
Owner Name: _ l��,g®-r,• S' ��r�./`�j a- Phone:
Mailing Address:
Physical Address:
Facility Contact: &2&— Title: �f,!//jClrJ Phone:
Onsite Representative: Integrator:��%�y��
Certified Operator: ,�'�`"�� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design Current Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity ':Pop:. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dai Calf
Wean to Feeder
Non -La er
Feeder to Finish
r Daig Heifer
Farrow to Wean
Desi gn Current D Cow
Farrow to Feeder
f) . P,oul
Ca a_ct l?o Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
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:
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 J!�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of ins ection:jefW
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z_I�t
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes IQ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo
❑ 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): COI4/ l-',��A sl�6/01� 3, � rr�rnaddL /D!/L!`SfYd
13. Soil Type(s): D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eallo ❑ 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 [S No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [21 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes C�5-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 P5 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&No
[] NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

• Facility Number: Date of Ins ection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CZ No
t 25. Is the facility out of compliance with permii conditions related to sludge? if yes, check ❑ Yes S 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 CS No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [?jNo
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 ReviewerAnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 2g No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes to No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
[:]Yes CANo
❑ Yes 5d No
❑ Yes CK No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to_ question # •'Ex lain an YES answers and/or an additional recommendations or_an -other comments: _�� _
( 9 )� . P Y y _ _ _ Y �.
Use drawings of facthtV to•betterKixplain situations (use additional pages as necessary). - - __ s a..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone- 33 i)O
Date:�� �i r
21412011

i _ .... ...... of Water Quality fi
Facility Numbert`� ! O Division of Soil and Water Conservation
0 Other Agency
Type of VisitCpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
a.ommRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: :r County: O"-�f Region:
Farm Name: 1a AT !" eaJ,, : SDI'+- Owner Email:
Owner Name: DRYS Phone:
Mailing Address:
Physical Address: Q
Facility Contact: !� O�^ - s ���f BTitle: p` n �� Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ ` 0 " Longitude: = ° ❑' = "
Design Current
aIlDesign Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
on -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ 1 a ers
❑ Non -Layers
El Pullets
❑ 3'urke s
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Other
❑ Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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
SNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection r/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 Qr
Observed Freeboard (in)- I"s,;)-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[9No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[j�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
D�No
❑ NA . ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
IZNo
❑ 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
09 No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Z-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
[XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
JR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S,No
❑ NA
❑ NE
Comments (refer to question :#): 'Explain any YES"answers and/o _ i � � T
r any�recornmendatiins or�anv other commen ts.
Use dra�rtngs of facility to better explain situations. (use additional pages asnecessary) h _ --
AL
Reviewer/Ins ector Name -__ x Phone:
P 970-4133-33Dfl
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes aNO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 54No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes &No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [.No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ES 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
9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[ 1 Yes
9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
'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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ANo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 01fompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ; Op Departure Time: County: 7' Region:
Farm Name: rl a ri ez ��d� S IQAlt,/)'►'L' Owner Email:
Owner Name: rA 5Vn-t-er�tn _ Phone:
Mailing Address:
Physical Address:
Facility Contact: A570PI, Title: Phone No:
Onsite Representative: 'i;ia
Certified Operator: ,!_ _e_
Back-up Operator:
Integrator• f!CrS��r� _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E:] o [--]' E_] u Longitude: =] ° ❑' = u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I I
El Dairy Calf
Feeder to Finish /
El Dairy Heifer
ElFarrow to Wean
Dry. Poultry
El Dry Cow
ElFarrow to Feeder
El Layers
Non-Dairy
El Farrow to Finish
ElBeef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Broad Co
Turkeys
Othe-
TurkeyPoults
rElOther Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ELNo
❑ 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
Q No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — O Date of Inspection
tiWaste Collection &Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): LI
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Tio ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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 [9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [&No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 rype(s) J5&/'rnu.�qf t //vrrt 1 r0Vj r=s / UJA- 1 <A_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop andlor land application site need improvement?
❑ Yes
B 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
54 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to q e�sti6n 4) Explain any YES answers andlo"r any r com tendatto'iis nr a"riv other comments ,
- r
.Use drawiings of facrlit} t'�o better explain situations. (use additional pages` as rie essary):
PD*"C =°a i`►y¢��` Il�f ; lr as �Yc�t �i eat•
U
Reviewer/Inspector Name " . Phone: qJO 00
Reviewer/Inspector Signature: Date:
rZi«ug uananuea

Facility Number: gV,— ( Date of Inspection p—dq
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5� No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O 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
fR No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ONo
❑ 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
QNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
BNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® 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
fi� 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
RNo
❑ 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
Pallo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
12/2&104

' i�zsioa of Water Quality �y
Facility Number �-- 1 O Division of Soil and Water Conservation jJ
Other Agency
Type of Visit
Com ' nce Inspection
O Operation Review 0 Structure Evaluation
Q Technical Assistance
Reason for Visit
Routine Q Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: f County: Region: E9_02
T1 /111
Farm Name: ��(.1'S® �J�Q�SEY�— _CZri'�'� Owner Email:
Owner Name �Ci_i n �GpQ l4 �- Phone:
Mailing Address:
Physical Address:
Facility Contact: y Title:
Onsite Representative: _.I_ n
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 6 Longitude: = ° =
Design Current c Design Current
Design Current
Swine Cap ty Population Wet Poultry Capacity Population
Cattle
Capajci�ty Population
to Finish ❑ La er
❑ DairyCow
to Feeder on -Layer
❑ Da' Calf
r to Finish - -
w to Wean Dry Poultry ,.
w to Feeder "
w to Finish ❑ La ers
❑Non -La ers
FGilts
ullets❑Beef
Turke s
DairyHeifer
❑ D Cow
El Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
Brood Cowl
I❑
❑ Turke Poults ❑Other
- Number of Structures: r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q9.NO
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®+No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

I Facility Number: — Q Date of Inspection
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3No ❑ 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
E.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
14_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
19 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IQ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
$d No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or t0 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)
11
Soil type(s) �Q
/
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
W-No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Jallo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
gNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ NA
❑ NE
Reviewer/Inspector Name r r "�-� Phone:f�
Reviewer/Inspector Signature: Date: - 0 (U)
Page l of 3 12129104 Continuer!

1 Facility Number: ( Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check ❑ Yes 13 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z 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
14 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Ycs
allo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EN No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CkNo
❑ 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
Wo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�R) No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
tZ No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
AddthC anal omments andlorDwuigs
Page 3 of 3 12128104
Page 3 of 3 12128104

M
L
9%1Div111-
ision of Water Quality ��' 7
1 �� M� Facility Number O DiAsion of Soil and Water Conservation ! V 17 0
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Or<outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date orvisit: _07Arrival Time:IDeparture Time: i County: `~� Region:
Farm Name: _Nr610rL Fei2ayH- f�r2f __ _ _ Owner Email:
Owner Name: it— J? &A e-S D w Phone:
Mailing Address:
Physical Address:
Facility Contact: ?72fa15'D~ Title:
Onsite Representative:-�-- -
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: �:2Z�_
Operator Certification Number: 40?4
Back-up Certification Number:
Latitude: E__1 e = ' = Longitude: E__1 o = ' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
^^ �' ❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Covq
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 diA�41_Fjrom 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 K.No [I NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ No
':- rE]We' s
K No
❑ NA
❑ NE
❑ Yes
X_No
❑ NA
❑ NE
12128104 Continued

/1
Facility Number: 8' — Date of Inspection?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
[4 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
'0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes MNo ❑ 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 14 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 JCropr Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area /
12. Crop type(s) �rrvrt�a-1©yyrr� ��iC� i .d -��hr�r��nh �C'Or`n /Sfly�v�
13.
Soil type(s) N O td
i
I4.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
54 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16.
Did the facility faii to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
14 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
$LNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1 T l X
ReviewerlInspector Name Phone:
ReviewerlInspector Signature: Date: A92 7
12128104 Continued

r
Facility Number: Date of Inspection ezft 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El 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 9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,K No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26, Did the facility fail to have an actively certified operator in charge?
❑ Yes
XV No
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
14 No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit
ompl' nce Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: % Arrival Time: f�.',3s Departure Time: /S1 County: Region: oe
Farm Name: ten&. - gals Er— �� _ Owner Email:
Owner Name: ))2r '' Reac rS fa �_ Phone: i
f L� L ` Dr"N Mailing Address: "'!%J� Il" � �U%�LCj �7� � n�" c,
Physical Address: yy�� �
Facility Contact: Z29D r
— 7 e¢r-J SV ­' Title:
Onsite Representative:
Certified Operator: Y:T ter
Back-up Operator:
Phone No:
Integrator: //r4=
ZFW
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = { = " Longitude: 0 ° = i
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Popalation
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Da Calf
56 Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
pry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non -Dairy
Farrow to Finish
IE
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑ Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Co❑
Turke s
Other
❑ Turke Poults
❑ Other
Dumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
N No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
E.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
EgNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9_No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[M-No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LXNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[R 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?
04 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E@ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[4 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
[&No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ 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) j�,rrvt uril-rr���%
r'V'9A
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JINo
❑, NA
El NE
15. Does the receiving crop and/or land application site need improvement?
RYes
070 LJ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
161 No
❑ NA
❑ NE
. eme 9n e w • It c o" l 6O / 00 i(
Reviewer/inspector Name �/� `�� Phone: 2zoes 33-5
ReviewerAnspector Signature: Date: p4
rage l aj 3 121-16114 c.onnnuea

t
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
HNo
❑ 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
f,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
5allo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
g.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
JzYes
�o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
5�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
fZNo
❑ NA
❑ NE
Additional Comments -and/or Drawings:
G L, , T, J F%O r-- U r7Jri &ra; '�,Z % r\, 40 5'e
Page 3 of 3 12128104

Division of Water Quality��;j
FaAty Number0 Division of Soil and Water Conservation 3.
-----
Q Other Agency:
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit & Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 6AZ3/0 Arrival Tinzc: Departure Time: County: sat —I qA_ Region:
Farm Name: �drr+. Owner Email:
Owner Name: �as s;-► _ Pc a r.s a N_ Phone.
=19 —
Mailing Address:
d -a - LJ
d��Qi�-v_c�� -.c4.
Al C ptr3 as
Physical Address:
'�c�z�ut'
z- . _
Facility Contact:
Title:
Phone No:
Onsite Representative-
�u+oA.,'
Integrator:
Certified Operator:
f3
�ra ¢rs_o
Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 0== Longitude: = 0 0= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
yv
rF�2-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
L.1 Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-madc'?
Design Current
Cattle Capacity Population
❑ Dai ° Cow
❑ DaiTy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State'? (If yes, notify DV11Q)
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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(0 No
WA
❑ NE
❑ Yes
N No
El NA
❑ NE
12128104 Continued

Facility Number: Z — ,?mil Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
i
Identifier: _
Spillway?:
Designed Freeboard (in): !9 0
4
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
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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 UNo ❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ffNo ❑ 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) /llr�rsac ram cam. r�. •� ..S / S J
13. Soil type(s) /K/o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5LNo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑
Yes
qNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[M No
❑ NA
❑ NE
- .d'�::u�`'.�:F r ti _•. 4,m --,�'�'a?:�'•.n'�Lr�,:-;ea.'�±�ok�i.�?s:F&I�,-�i.
e- !e era w e.i cs- st e� o a .i 10 G A3 f
Reviewer/Inspector Name �. r , Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

FacilityNumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? [j[ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check N Yes RrNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists [V Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [?Yes ❑ No ❑ NA ❑ NE
❑ Waste Application 1�-e Ana ' 1 pp El Freeboard El Was Analysis ❑ Soil,, Analysis ❑Waste Transfers ❑Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections R<Onthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
C4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[jrNo
❑ NA
-❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Add1t14naI Conameots=and/or Drawtn
.. .. a.. b"c
L o r O 1 i► L p r v. �' GtC� s c J 0z L wf � em �GT \ a 0 r
PG� e- p lacC C_ c d r y CA- t"'1 C_ GtA-V- --c 4- C O C, -VL-e— O i�
��r%_ rG 40 V'C9_S
�.�. . 1 c �. +r,
ki u �U �. 1 �J.1 Yra C�,i' i � t;'. � CN" (]Y' C.ir4 1 y � V G
.� 1 i
4eb
12128104

ti
Type of Visit 0 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Aocess
Facility Number Date of Visit: S-ZD 6 H Time: : v 9l'i
ro Nat Operational 0 Below Threshold
Elrermitted O'Lertified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ........... iA.S_un------ �.......... f-Sax-M----------- County:
Owner Name :..... _ ........ scr�..:w._......1._ i s,c a ... ........... ........... Phone No: .mrl t`�? _ ... Sy o.. 3g ..........
Mailing Address: _W .... � ��h!szZ Z_C"4-_----- --------��
Facility Contact: ............... JG �r� ._- �°t°�c.'Sc.n Title:.. ............... ..... ...... ..._. Phone No: _. 2
l0- Ili
Onsite Representative:......... Slimsh_t_e_ors.nr........... ...__----- ----------- Integrator:---?�rP� ��� �_........--------__......_____-
Certified Operator:_......._.-, ?.G �•,�-�----- ���t�r � _ .W ._........ Operator Certification Number:. -2-�..
Location of Farm:
EI.Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 &° Longitude • ' 64
Swine
Wean to Feeder
E3Te—edertoFmish
vqtjo
D
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nuiuher oi%agooi
HnIdin9:PondcIRA iIid
cif
hirer .Cattle
❑ Layer
-y; ❑ Dairy
❑ Non -Layer
r ❑ Non -Dairy
T_ :7
Other
Total DesignMCapaci#y :L
Total SSLW . NL
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 gaVmin?
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: ............ t................... -........ ..... ----
Freeboard (inches): .2-7 '/
❑ Yes Q�W
❑ Yes 13-Wo
❑ Yes [g-N-o
❑ Yes
[}No
❑ Yes
G-No
❑ Yes
M_AIo
❑ Yes
Structure 6
12112103 Continued

1
` )Facility Number: Date of Inspection Fn�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0-No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Flo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [2-N-o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes UNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [EI-No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes S-No
l 1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [Wo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type B/�m r, // �rrt. �/, .,l/r i�rrri dr.�f Ct�r n el 6 . fJ fl.n s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [moo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑,No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ io
c) This facility is pended for a wettable acre determination? ❑ Yes 91No
15. Does the receiving crop need improvement? ❑ Yes E]No
16. Is there a lack of adequate waste application equipment? ❑ Yes C No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 �o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 13-rlo
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 ONO
Air Quality representative immediately.
gFreld Copy ❑ Final Notes
l ry
WtI'C
Q TG'kj
rj lrrG// lPl,15 Cr rnc•n�
` /�� iG�L�Hc'«I,OJ'!�` �� 7�� �UJ
`��vsPs
7t�G�
nele
�a 6e S�.c wL!/r�
���s 04e 4ree 0")
o„
('Ve,//
AAaA n A0 be
remavr�
Revtewer/InspectorName
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: �d f Date of Inspection 10 r?
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Doesthe f ility fail o have components of the Certified Animal Waste Management Plan readily available?
(ie/ chec , des , ma)sf tc.)
23. Does record keeping need improvement? If yes, check the appropriate box low.
❑ Waste Application ❑ Free�et�d ❑Waste 13 ❑Soil pling
s-1(7 i -2.q %�-�O 1%,5' S i�,rj 6' 5-_7 2.3
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative.?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes [}#
❑ Yes am
❑ Yes [.a-hio
❑ Yes ❑-No
❑ Yes allo
❑ Yes �o
❑ Yes ©-No
❑ Yes LWo
❑ Yes P No
❑ems ❑ No
❑ Yes [LAlo•
❑ Yes ❑-No'
❑ Yes O NS
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑.lsiar
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes O-No
❑ Stoc it . Farm ❑ Crop Yield Form ❑ �"""" ❑ Inspecti fter V Rain
❑ 120 Min nspections ❑ Annual cation Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address:
County:. _ ` #,V P
DATE: — / ff , 1995
Time: iG Af
S d1l /(0-,a- Alt 5
Integrator: rG s'c" c_' Phone:
On Site Representative: Phone:
Physical Address/Location: r _ ST; l%44 ..tt^t,csa�.t•• u}1 Se t«� nsa+� u•�b►-,
Type of Operation: ine Poultry Cattle
Design Capacity: Number of Animals on Site: J 9 /)
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: " Longitude:4 ° "
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)
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized:
or No Actual Freeboard: Ft. Inches
on(s)? Yes or66 Was any erosion observed? Yes or a
or No Is the cover crop adequate? 9 or No
Air L jo,L�"u7)1+
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin fiaor No
100 Feet from Wells? � or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 10
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ordQ
Is animal waste discharged into water of Oe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management recir s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (s or No
Additional Comments:
Vokt- ,o00mr,
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

RORT$ CAROLINA DEPARTMENT OF ENYMONNNNT, EXALTS b KAT[]Rritr IDS
DIVISION OF Eh'MONPOWM MMAAC320M
Fayetteville Regional Office
Animal Operation ComplianCe InSpectiOn Fora
? Bltl�i iQAME%OWI�k3 '
EG`rion-DATE;
� k'
r arms �a r�
�Z� 4 box
10:- 5cf0- 3bI
All questions answered negatively Will be discussed in sufficient detail in
the•Comments Section to enable the deemed Permittee to perform the appropriate
corrections;
5EG`TION Y
Animal Operation Type,:�
hn�s
Horses, cattle, ine, poultry, or sheep
SECTION 11
VA©
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)]
Z. 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 C MTx'PIED ANIMAL
WASTE ISWGEMENT PLW.
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

Ss�aN =zI
a
k1g1d
Si an
1.
to animal was Lw es WeRri lM Or lagoon
construction within 100 ft. of a USCS
Nap Blue Line Stream?
2.
Is animal waste land applied or spray
irrigated mi *h4 n 25 ft. st a UUGO Xap
Blue Line Stream?
3.
Does this facility have adequate acreage
on which to apply the waste?
4.
Does the land application'aite have a
cover crop in accordance with the
CMIFICATI Q PLAN?
3.
Is animal waste discharged into waters of
V
the state by man-made ditch, flushing system,
or other similar man-made devices?
5.
Does the animal waste management at this
/
farm adhere to Best Management Practices
(SMP) of the approved CPS ZZC TION?
?.
Does animal waste lagoon have aufficiennt
�
freeboard? How much? (Approximately
$.
Is the general condition of this CAFO facility,
✓
including management and operation,
satisfactory?
Comments
313019+
Reqslcrrd -Fo l I owed Cer -h ca ti �1

AMU" lahm am = I FLAX CZRTITICA?ION and MW OR IMSAJ D YI=LO?t
Please &stun trio oa■oleted edam to tka Division of znviroanental Vanavemant at
the 44dteaa as tie wavemse aid+ ad tiles f oss .
Mace of rats (lease
Pt • 1st) s [ 9.,: tl
Address:. r
Phone No . -
_. County:
Fa= location: Lat4tude and Longitude: __JIA° 542 /ZS°_� ;re.;_irad) . Also,
Please attach a copy of a county road map with location identified +
7pe of operation (swine, layer.., r1, etc.) _ _ f)&j�A- Fas C16
^ezlgn capacity (number of animals}`t - - ?'rn - _ -
Average size of operation'(12 month: pcpulatioz avg.):
Average acreage needed for land application of waste (acres)=
aarsrssr rrarrsssrsa sr Asasass rarsssssassrasessrrasrsasssarawrrs=a s:=ass:ssasrss
+ lec =Ical spaaialiat Cartificatioa .
As a technical specialist designated by the North Carolina Soil and Water
Conser-ration Consmission pursuant to ISA NCAC 6F .000$ ' ce, =__y that the nww ..-
expanded animal waste management system as installed for the fa:-: named &:^.ova
has an animal waste management plan that meets the des--';,-, ccnstruc_icn,
operation and maintenance standards and specifications of the Division of
Environmental Management and the US=A-Soil Canserration Ser-rw=_ and/or zhe Ncrth
Carolina Soil and Water Corserratior. Cotrmiss on pursuant --= ITA NCAC SH.02I7 a-d
15A NC= 6F .0001-.0005. 77he following elements and their ccr_esponding mi_^_isu.:.*a
criteria-havAL-been verified by me or other designated technical specialists a:.d
are included in the plan as applicable: minimum. separations (buffers); liners cr
equivalent for lagoons or waste storage pcnds; waste storage capacity; adequate
gi;antit-y and anount of land for waste utilization for use of tnird party) ; access
.r ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the corzrol of the discharge
of pollutants f dm stoz=water runoff events less severe than the 25-yea-r, 20-hour
storm -
Same of ftc!=ical specialist (P1 as 7;I n ,) �+"►
Aa_iliat-on: Z iA:Fpla
Add-ress {Age:tcl) _ Phcne I-
S4 gntra- c afL�: ��
a;.30 - 9!L
.......... r .......................................
i e
Cwaer/S±anager Aq=eamaat
(..re) unc!erstar:d the operation and naintenance procedures est3 '_-s'ed in the
approved animal waste ma..agenent plan for the fa_-`:~s rased a o:e a.:d wi:- _ _'e_-aert
:hese=_ccedures. I (we) k-.ow that ar._v additional ex;a:.sio.. to _he existing
design capacity of the waste treapent and storage system or ~_mnstz%at:on of new
facilities will rewire a new ceiltification to be su mitted to the Division of
=nvirortnental Manage-mert before the new ani_zsals are stocked. (we) also
.:.dersta.^c that there must be no d43C arye of a. -tuna? -waste fz=m :,'. _s system to
s;.: face :+aters of the state either thr-nuch a man-made ....__:e-zance or
_...off Zzcm a szc-Z event less severe than the 25-Yeaw, 44-^a-4_ stz:-t- The
a;provec ^la:•. wi _ be f, red at the fa---t and at the ozfzce _-e _..cal So'__ and
..ate. Ccnserrat-on District.
_7aae of Land 4w=pr (Please ?tint):`j• -- •/ ! - i•
✓41late:
game of Ha=2gar, if different f_cm owner (Please print) :
Signature: oat
Vote: A change in land ownership requires nocification or a new pert=_ -cation
(if the approved plat: is charged) to be submitted to the Division, of
Fnv:ror_:ner_tal Management within 60 days of a title transfer.

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Site Requires Immediate Atten 'on:
Facility No. 2
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIQNS SITE VISITATION RECORD
DATE: 0 - l , 1995
Time: .'2 a 14A /I
Farm NamelOwner: r177XXA,)!per RR <o - V r!Ore-41 S
Mailing Address: 15v A 1 ? Z
County: ^� #Aep aw - T
Integrator: F D .r T'ra t- Phone:
On Site Representative: Lr Phone:
Physical Address/Location: ,7 7-iAIII-C /i1' 441A7'0/5 6 c ;�ffl-v. AFr�2
CM6"*y �-rel9v 1 /z,u.'�,u, . %urr� l c ifo�✓ 5/e 1 -6a 3yM; rs d-.v �,ri✓ � �.Y �AiC�_%
Type of Operation: Swiney Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: " tV/g!�0 X3 ~ 00 9 17-/7-a
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? Y , or N
Crop(s) being utilized: (-�/) 5 P
Actual Freeboard: =Ft. U Inches
Yes or to Was any erosion observed? Yes or tG
Is the co er crop adequate? )9 or No
�� �uJ�
Does the facility meet SCS minimum setback criteria?
200 Feet from Dwellings? YG1or No
100 Feet from Wells? Yj�)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or W
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orN-s
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or Wjo 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)? )!� or No
Additional Comments:
s
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

I ORT8 CAROLII91 DEPARTIERM of , EMALTB a MATMAL CES
DIVISION OF g,M tONNOM lL KANAGEM4'r
Fayetteville Regional office
Animal Operation Compliance Inspection Form
.v.dryri- ;'.^r�'w": r.-�i'+ -^
-= T AANN..77 iJAilLR...s'd.V. ti..t-v`a�fi.i:A�
NNW
.,fir'yc�..:"..A+<�`L���+y'"'�y_.5�.',fg
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•+: „y:.i4:,,,.,�ia rpt:�}�:.<�..rp..
d� �i�i...a7WJaOc1 a..
r n I-0 rms MO rK- ea rson
�.v
sL)x I-1a a Gintm ZS322)
td - a--5106� a
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
sE�zaN rr
An
imal ration n ish
Horses, cattle, 4win01
poultry, or sheep
g=:rNII
1. Does the number and type of animal meet or exceed
the (.0217) criteria? ECattle (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 REGISMATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a iKRTIPIED
WASTE XLLMcEMEN'r psAM
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the 5CS minimum
setback criteria for neighboring houses,
wells, etc?
M©
V_
I✓
M
I

4-
8R(=Pff iYI
Keld
sitsi maniumm-ent
i.
7o animal wablw sWeVilad d! lagoon
construction within 100 ft. of a DSCS
Map Blue Line Stream?
Z.
Is animal waste land applied or spray
irrigated wi*htn ZS it. of a UUGD Map
Blue Line Stream?
3.
Does this facility have adequate acreage
on which to apply the waste's
4.
Does the land application' sits have a
cover crop in accordance with the
CZRTTIFICAT2PN VLAN?
S.
Is animal waste discharged into waters of
V
the state by man-made ditch, flushing system,
or other similar man-made devices?
6.
Does the animal waste management at this
/
farm adhere to Best Management Practices
1/
(SIP) of the approved T TI
7_
Does animal waste lagoon have sufficient /
freeboard? How much? (Approximately _A
i
$.
Is the general condition of this CAFQ facility,
including management and operation.
satisfactory?
SE(. ON IV
Compents

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FORM = GR SiIIVL- L OPERATIONS
Departaent of Environment, Health and Natur a- Resources
Division or E.nvi_cnmental Management
Water quality Section
If t::e animal waste management system. for your feed? of operation
is
designed to ser*re more Char. or
equal to 100 head
of catty e,
75
horses, 250 swine, 1,000 sheep,
or 30,000 birds that
are served
by
a 1 cu.; d waste system, t en th-4 s
fc= must be filled
cut and mailed
av December 3: , 1993 pursuant _
_=A NCAC 211.0227 (c)
in order to
be
deemed pe^:itted by DEM. Piease grInt clearly.
Fa_^.,t Name: -Re
Q f Wit' r1 ffa ;r ry­� �^ _
Mail_:+c Address:
Count v : f'-n C'r-r� Phone No.
Owners) Name: �ierh-ea� &Jerk- 17r��t_►-=ri'1
Manacer (s) Name:
Lessee Name:
c ar:n Location (Be as specific as Passible: road names, direction,
milepost, etc.) l n K -7L 1 +T, r-jLj
r)P r i; rn4r-)n (t V4p,. r me c,', nc. -+hP u I n ne. c-, I I r•n6 1�C.
Lat;4ude/Long itude if known: (1,h ?*�'.:Q3 -.rL'�G - i-_.i I - n .+
Design capacity of animal waste management system (Number and type
cf confined anima= (s)) 1 F= 6f.
Average animal population on the fain (Number and type of animal (s)
-raised) , �.� rvn r rLa n Lc -IC _
14 Year Production Began. �99� ASCS Tract No.:iL 71(0`1
Type of waste Management System Used: Lae n
� .J
Acres Available for Land #plicAtroq o�f-7Waste: „Q9
Owner (s) Signat-ure (s) :,.c�r..�i� l� l' 0A7r_:s /7-
DATE: