820205_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

i
Type of Visit: Or -Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: tine Q Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: a County: si' Region:l��
Farm Name: ���` i�� ��?�� Owner Email:
Owner Name: �9-,��d� � �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: C_0 Wr, L Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design"A
Current
t �' ' Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap
Cattle Capacity Pop.
ni
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
�� D
`�I
..
Dairy Heifer
Farrow to Wean
-
Design
Curreat
D Cow
Farrow to Feeder
k•
D . `P.,.oult .
Ca acI
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
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 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 E No
❑ Yes D No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

• Facility Number: jDate of Inspection:
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ffNo 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): / 9L
Observed Freeboard (in): ,�A3
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 D 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 ErNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LI-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 E31No NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes E 'moo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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): ri-r, v-)A_
13. Soil Type(s): pf) A-.
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes []'(a
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA []NE
❑ Yes Ej 110 ❑ NA [] NE
❑ Yes FD No ❑ NA ❑ NE
Rtguired Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes DNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes No
❑ NA
[] NE
Page 2 of 3 214,12015 Continued

Facili Number: I Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes rNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge Ievels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L'J No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes []No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes El"No ❑ NA ❑ NE
[:]Yes []] No ❑ NA ❑ NE
[—]Yes 0"SNo ❑ NA ❑ NE
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 [3',4o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [q No ❑ NA ❑ NE
Cam»ents i'efer3a. nestion::#{ iE lain -an` YES"a©sweirsr"audtor' a4 sdditignal reCgmnteudat+oos'or ao 'other CO-4— tints - �:0 il' i'.
w I+Iir f ''ae yph;.i)r. y{f9 li�llll" ;2�er .;.. yli+,wNlln,r...y v a I,al;IliFlk ,, yl 1,1A �'k�ylll'il'cl +�!I�
Use drawurgs. of WWI*to better explain situations- (ase adtilllr�anal;pagcs'as necessary . x, .. �h`�I+ I IJ�I+
Fat,­wj Nz
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

- ►vision of Water Resources .
Facility Number Division of Soil and Water Conserv»tion
r
O Other Agency,
Type of Visit: ompliauce Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
[lesson for Visit: tine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �/ Arrival Time: ,'L-)O Departure Time: c7 County: , �cr�y��- Region:
Farm Name: a w1_5 Owner Email:
Owner Name: o afx Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Integrator:
Certified Operator: /✓' Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
.f . 1 ••, -• .WMill
Design Current Design# Current
Swine Capacity Pop. Wet Poultry Capaacity Pop.
Cattle 'd
4i;
Design Gnrrent
Capacity Pop.
Wean to Finish
Wean to Feeder
airy Cow
airy Calf
Feeder to Finish
Farrow to Wean
/ Q
C53-
�,"'
D P,oul ;',i,
Design
.Ca ac'
Current
P,o ;:.,
Dai Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
I a ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r
[?t e ro,
Turkeys
:r t
'
ITurkeyPoults
Other
101hpr
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 ff5 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:)No
❑ Yes ❑ No
❑ Yes No
[:]Yes �, No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

j Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B 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): 13 3�
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 allo ❑ 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 Ea No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EQ 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 ffNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J�g_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ �Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYPe(s): rlr7[.� / ty
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No
❑ Yes ® No
❑ Yes [y] No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑Yes ®No DNA El 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 f�g 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 ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E--No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - jDate of Inspection: ;2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
t 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes B No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
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
® 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
ED 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
E3-No
❑ NA
❑ NE
Comments (refert gteeshon#) �ExplaEn`any YES answers anlor any additional recommendations vrriany other comments.
Use drawtn�s.ofkfacility to tietter explain situations (use additional pages as necessarv). -
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Phone: 5P3--2/, j^ (
Date: —
21412015
Page 3 of 3

Type of Visit: I61'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: IC Arrival Time: d' a0 4 Departure Time: County: �cpptpkj Region: Fgo
Farm Name: EAf rriS Owner Email:
Owner Name: i k 0 ykj&s IM Ok I— ,1.4 Phone:
Mailing Address:
Physical Address:
Facility Contact: r�o a s leaf r.� Title: C CO'n e{ Phone:
OnsiteRepresentative:-tkow,a MeL i:Yw;s Integrator: prp., -eiR p
Certified Operator: 0 W V% e r Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current aDesign
Earrent
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Im
Capacity Pop.
Wean to Finish
[Layer
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
eeder to Finish 1 O O
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P.oul
C*.a aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Points
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? 0 Yes ETNo ❑ 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 DW R)
❑ 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
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[D"N' o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2015 Continued

Facility Number: I ©' jDate of Inspection: 10
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 '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
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [t]"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 [ErNo [DNA ❑ 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 D No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2No ❑ 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 El"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ,-ol vt/5Pe
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[]Yes
EfNo
❑ 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
[ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? [] Yes E] 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 dNo ❑ 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 [i"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 El No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No E!(NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: a-- aOS Date of Inspection: 10 a
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes [/] No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [:]Yes dNo
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 [Dfo
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
❑ Yes
Ek<o
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
[2�<o
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
dNo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ff"No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
DNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[No
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
Date: 7dA f"
21412015

ylic- /,;z -/.s
IType of Visit: (&j-Comp iance•lnspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0-1routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
l Arrival Time:
Departure Time: ;
County: Region:
Farm Name:
Gtd`
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: g7 6cln Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Current
MENpacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish ILayer Dairy Cow
Design Gurrent
Capacity P.
Wean to Feeder
Feeder to Finish /� fl
I
jNon-Larr I
Dairy Calf
° _ t" k� "`" 1xt
Design Current
`D . P,oul C ci P,a P. _
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
11 Other
_.. ,.
-i
Pullets
Beef Brood Cow
y'
Turkeys
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 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 U2�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes J No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - O Date of Ins ection:
�. Waste Collection & Treatment
4. Is 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 g
Observed Freeboard (in): ---L-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
SNo
❑ 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
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[—]Yes
C.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
[0 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):���
13. Soil Type(s): �GC h o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes DINo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fZ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[S' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ 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 M3 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 q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No ❑ NA ❑ NE
Page 2 of 3 T 21412014 Continued

■ Facility Number: 8' - Date of Inspection: — g F
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes M-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 E.No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 CAVRAP?
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 5No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes C] No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question#) Explain any Y)ES answers and/or any: additional recommendations -or any:otber c.:ornments;��
�, = .
-77
Use drawings of facility to better explain situations -(use addihonal pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: J6
21412014

Type of Visit: &Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: I! Arrival Time: , t7 J Departure Time: County:9
Farm Name: 7"'d- -P reran s Owner Email:
Owner Name: ]ephy _c mdf 1-Wi3 Phone:
Mailing Address:
Physical Address:
Facility Contact: '�1fti'�a= ! f Title: Phone:
Region:
Onsite Representative: Integrator: /r' r
Certified Operator: J, Certification Number: k 2/7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I lNon-Layer
I
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
D . RUE Ca aei. P,o ..
Layers
Dry Cow
Non-D '
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Imnacts
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 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 LEI.No
❑ Yes JZ No
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
Page I of 3 21412014 Continued

Facili Number: -jDate of Inspection:
Waste Collection & Treatment
r
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Dg.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): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 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
Cj� 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
[9.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 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
Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i'nr udu 1,7 U ti�ecZ —
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 and/or land application site need improvement? ❑ Yes Eg No ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 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 ®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 25 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0[ No ❑ NA ❑ NE
the appropriate box.
• ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [l No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [jStocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �&No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3 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
10 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
®No
❑ NA
❑ NE
❑ Appiccation 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
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
22 No
❑ NA
❑ NE
Commen#s (refer to questian#f) �ExplaEn any: YES; answers:and/or any additionaiirecamamendations°ar any ether comments 91
Use dr_avvings of •fa_" ity two Bette ei-lain situations {use additional pages as nec` ssary)
Reviewer/Inspector Name:✓� f.1�r�►� Phone:p��.A
Reviewer/Inspector Signature: Date: ;Z —oe,� joP
Page 3 of 3 21412014

}
Type of Visit: (JComp "ance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: �f
Farm Name: Owner Email:
Owner Name: pn?a5¢�s %5 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ^1r-Vs,.t�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
integrator:
Certification Number:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Design.,
.Current
Design Current
Swine
Capacity. Pop.
Wet Poultry
Capacity
Popes
Cattle.. Capacity Pap.
Wean to Finish
Layer
IDai
Cow
Wean to Feeder
I INon-Layer
I
alf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
@urgent
Dry Cow
Farrow to Feeder
Dr P,ouI
-a aci
P_o . -
Non -Dairy
Farrow to Finish
Gilts
Boars
I I
I
11-avers
Non -Layers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
ll 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?
❑ Yes KNo ❑ NA ❑ NE
[] 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
0,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - flC I Date of Inspection: — l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):� r
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[3JVo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes RNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
O_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 br improvement?
[:]Yes
fallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VCLNo
❑ 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
0 No
❑ NA
ONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J?]-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): ac���r�
13. Soil Type(s): �A u / 4 2Z
14. 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 PLNo ❑ 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
2LNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&jNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RINo
D NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

• Facility Number: Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5d No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes a No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA 0 NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes
JS No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
jg[No
❑ NA
❑ NE
Comments (refer to questott ) Epulatn any YES answers and/or any additional recommendations or any of&er comments.
Use drawings of facility to betterexplaio situations (use additional pages as necessary): s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2jO2 —_r5EyD
Date: /�-lam7/3
21412011

Type of Visit: ('Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: /,6J�% Departure Time: County:, ___
Farm Name: fA.i�2 /fQa�`/fl Owner Email:
Owner Name: %NCr ;S Phone:
Mailing Address:
Physical Address:
Region: /—'�o
Facility Contact:C1S Title: Q'((f/t ram/ Phone:
Onsite Representative: �_ Integrator:
Certified Operator: � iLu/�ct , 5 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry .Capacity Pop. Cattle
Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
"'
Dairy Heifer
Farrow to Wean
Design
'Current
Dry Cow
Farrow to Feeder
.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
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 �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�.No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - I Date of inspection:
j�
Waste Collection & Treatment
+ 4. Is 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):
Observed Freeboard (in): _ J7 3 9
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 DWQ
7. Do any of the structures need maintenance or improvement?
ayes
2&Nolt
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LE 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
[5� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DjLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &z'is94
13. Soil Type(s): ,4 " , ;5 0 E
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Pa No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes JZ] 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 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 5a No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes MNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection: /�-
.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 IONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [N No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
10 No
0 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
JgLNo
❑ 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
Ea 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
� 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
1171 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2) No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/onany additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: Q 332�D
Date: � ,` A2/.2==-
2/4/2011
Page 3 of 3

(Type of Visit: UCompliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: O R/oufine 0 Complaint 0 Follow-up 0 Referral 0 Emerp-ency 0 Other 0 Denied Access
Date of Visit: —// Arrival Time: p Departure Time: CounRegion;7
Farm Name: P
Owner Name: y14- T{1��ra5X
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 6t /13 Title: (,(J . Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm -
Latitude:
Integrator:y��
Certification Number: _ 494_
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
='1001113 .
Capacity
Pop.
-
Cat#le Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La yer
Dairy Calf
Feeder to Finish
` "'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poult ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
113eef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
n 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
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No $a NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No 10 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours andlor 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
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ,QC No ❑ NA ❑ NE
❑ Yes to No
❑ Yes IR No
❑ Yes IN No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #)::-Explain any YES answers and/or any additional recommendations oriany=other-comaie-nts:
Use drawings offacility;to heater explain situations (use additional pales as necessarv).
Reviewer/Inspector Name
Phone: I -'3 D�
ReviewerlInspector Signature:
Page 3 of 3
Date:
21412011

t
Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: % -� Arrival Time: %d'. a Departure Time: T i c7D County: a--- Region: _� D
Farm Name: _{�/� i`#ri'j't�s Owner Email:
Owner Name: �l4 ��� Phone:
Mailing Address:
Physical Address:
Facility Contact: .0 Title: iJG!/fYe'/'~ _ __ Phone No:
Onsite Representative: Integrator:
Certified Operator: ��-� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 =Ld Longitude: 0 o = ' 0 «
MQesignurrent
Design
Current
Deign •urrent
pulation
Wet Poultry Capacity
Papulation
Cattle Capacity Population
❑ Wean to Finish 10 Layer
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
El Calf
❑ Dairy Heifer
Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
El Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Dischar & Stream Impacts
I _ Is any discharge observed from any part of the operation?
❑ Yes
tO-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
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
U�No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 9;7-- Date of inspection
Waste Collection & Treatment
I 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 D3 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 2 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 [S No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R 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
l0. 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
&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)_-
13. Soil type(s)u,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[B No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Fk[ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®-No
❑ NA ❑ NE
Comments (refer to questaan #} Explain any YES ,answers and/or any. recommendations or any othe"r comments. =
�, p
Use drawn s of facili to better ex lam situations: (use addthona! pages as necessary)J.
" t_
Reviewer/Ins ector NamePhone: pia-�f�3 33aD P 7 s
Reviewer/Inspector Signature: Date:
--- -----
Page 2 of J ...,...... ..—

Facility Number: Date of Inspection
Y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2FFio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ NA ❑ NE
the appropriate box. ❑ V;LTp ❑ Checklists
❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R[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
ZI 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
F, No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[g No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P4.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
E51No
❑ 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
4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�3 No
❑ NA
❑ NE
12128104

Type of Visit O-Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ClRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �7 Arrival Time: Departure Time: County: Region
Farm Name: �t" rn� .{� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: 11
Facility Contact: 01 Q.6 LS Title: /h°l Phone No:
Onsite Representative: `57ir c_+ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o ❑ 6 = « Longitude: ❑ ° [� 4 = u
Design Current
Design urrent
Design Current
Sgiile
Capacity Population
Wet Pqultey Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
eeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ © Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
ElNon-Layers
❑ Beef Feeder
PGilts
Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Pouets
JE1 Other
Number of Stnsctures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
21 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[XNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®-No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1. Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ Z
Observed Freeboard (in): M3 `-113
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E4 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 El 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? 9-Yes ❑ No ❑ NA ❑ N E
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[XNo
❑ 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
RNo
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ug-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 Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
Crop
12. Crop type(s)
13. Soil type(s)' �[
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EgNo
❑ NA ❑ NE
15. Does the receiving; crop and/or land application site need improvement?
❑ Yes
BNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E[ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes '
Ej_No
❑ NA ❑ NE
L
Comments {refer to questran #) Ex lam any YES answers in' dlor any recommendations or any4other comments.
nz�
W�
Use drawings of facility to better explain situations: (use additiona1 pages as necessary):
6ohum 094kin .4'4_3e-
Reviewer/Inspector Name0e_ Phone: _�%C�''��_33t7 0
ReviewerA nspector Signature: Date:
12128104 Continued

Facility Number: Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2FNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 PNo ❑ 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
J&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
UNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B.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
ONo
❑ 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
CSNo
❑ 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
Wo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
12128104

Type of Visit omphance inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /ram Arrival Time: Departure Time: County: Region:
Farm Name: ? ,r,rM Owner Email:
Owner Name: zrt / 4"fgg z _ 11*7A - : 5 _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 7 17 fk= zZ_r, //firi "h ; 5 Title: Phone No:
Onsite Representative: Ste— Integrator: ��1`G 47 —
Certified Operator: .SctiC� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = u Longitude: ❑ o = t 0 U
Design Curren#
Design Current Design Current
Swine Capacity Population
Wet Poultry
CapIty Population _.. Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
d
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
_
El Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
-
turkeys
Other
❑ Other J.1
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [a -No ❑ NA ❑ NE
❑Yes
El No
[3 NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
Cl NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
E&No
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: ?', — Date of Inspection Y�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P4No ❑ 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): �[ g
Observed Freeboard (in): Iq 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes „KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[&Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes I,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 C3�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [K No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3 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) ///!ltVLt
13. Soil type(s)Ile
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Ca 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
JR No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
R No
❑ NA
❑ NE
Phone:
Reviewer/inspector Name 'r _
g/D��f37a
Reviewer/Inspector Signature: Date: ;7 T 7

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

I
Division of Water Quality 7--a
Facility Number 0 Division of Soil and Water Conservation
O Other Agencv
Type of Visit (D'If-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 04outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: U County: Region:
Farm Name: Owner Email:
Owner Name 6 !//Q / I frt f S Phone:
Mailing Address: _ � S,30 G MC) nA MA 9'.5 N C- 2& 3ge
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Integrator:t.-
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =. 0 « Longitude: = ° = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La cr
❑ Non -La cr
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
DTurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current;
Cattle CapacityP,opulafion
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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?
J
❑ Yes �&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �Nlo ❑ NA ❑ NE
❑ Yes [Z-No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
I
s Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J3.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?: 2
Designed Freeboard (in): { 7
Observed Freeboard (in): IV
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ 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? Ryes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ESNo ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5�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 Drill ❑ 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
V[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?.
❑ Yes
fS.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Callo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
JSNo
❑ NA
❑ NE
IComments (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):
PcJue,
r
Reviewer/Inspector Name Ue_ Phone: 2, per L{33>
Reviewer/Inspector Signature: Date: k -/0— Z
111251W Continued

Facility Number:92�_Q5rDate of inspection "1 D
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes PINo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. .Yes ❑ No ❑ NA ❑ NE
01vaste 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
fKNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
UNo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I�LNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PLNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CK 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
$allo
❑ 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
FINo
❑ 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?
�'es
El No
❑ NA
❑ NE
Comments and/or Drawings:
toe
Y
oa�'W)4w '—tXT';z
�T�
3 ,� r D�� 1 .v,11 ee m ehne &�7q
12128104

Type of Visit ( t—ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason €or Visit outine O Complaint O Foilow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:; Departure Time: ! 3 fl County: O'er Region: L�
Farm Name: 7tfi/ aP ref Owner Email:
Owner Name: zf- 417Zs3 Phone:
Mailing Address: 133 0 NO4�`-
Physical Address: I, j
Facility Contact:Title: Phone No:
Onsite Representative: :ZeUL_ cam
Certified Operator:
Back-up Operator:
Integrator: � C4&c: _
10,
Operator Certification Number: ZG 7z .;7
Back-up Certification Number:
Location of Farm: Latitude: = o = [� is Longitude: = 0 01 =
Design 061;wxnt
Design Current iii�Design Current
Swine Capacity Population
Wet Poultry
Capacity P,opuIN tion_ Cattle Capacity Population
❑ Wean to Finish
❑ Layer
airy Cow
❑ Wean to Feeder
❑ Non -Layer
airy Calf
Feeder to Finish
�/ s
Dry Poultry
❑ Layers
❑Dai Heifer
``
r=`;_ ❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Puilets
❑Beef Brood Co
El Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number af'Struetures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[3 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
O No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wo
❑ NA
❑ NE
other than from a discharge?
Page 1 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 QSNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ZNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?s _3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J,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
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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)�
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
&No ❑ NA ❑ NE
f No ❑ NA ❑ NE
ER No ❑ NA ❑ NE
WNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings:gf facility to better explain situations. (use additional pages as necessary): 1—
tA
Reviewer/Inspector Name S' G 1__ Phone:
Reviewer/Inspector Signature: Date: — p
A wgc Z vJ � «ic01v1# a v.rsnueu

Facility Number: — Date of Inspection Y
{ Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n [I Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. 91 Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
19 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
RNo
❑ 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
B(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
5kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XLNo
❑ NA
❑ NE
Additional. Comments and/or Drawings:
0 elx� jgv_'q� X/'�-
Page 3 of 3 12128104

Division of Water Quality
Division of Soil andWater Conservation.
F
i
Q Other Agency
Factltty Nu>Enber.
. g � a o S
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 6 �o%x Arrival Time: 9: /cS^ Departure Time: County: n Region: Fitts
Farm Name: -% /- �Qr ..,., Owner Email:
Owner Name: _ % %�,.,* a a /'1'1..�, i1 Phone: — 3 .1
Nailing Address: 1330 �~a➢Lrx ra taQ_ _ r � M.4-I .,-4 RA C U. r.+e,.�. � e � R3 2L
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: / /70M*.1 ey7d%tfi�;s Integrator:
Certified Operator: /Im!, % __ /Yl h n l--�: s Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: � e��= Longitude: ❑ o 0 t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La yer
❑ Wean to Finish
El Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
ElTurkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current I
Cattle Capacity Population
El
Dairy Cow
El
Dairy Calf
El
Dairy fleifej
El
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
El
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (Ii'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, notil}, 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 [Z No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[X No
❑ NA
❑ NE
El Yes
MNo
❑NA
El NE
12/28/04 Continued

Facility Number: jf '_ ,_10sI- 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?: 1
Designed Freeboard (in): _1.9 A' tr
Observed Freeboard (in): -315 Zr r9 n
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes "No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) YU
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [50 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes $0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑•NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [)I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) �rr..i..al4 ordsc�! 4$
---•--
13.
Soil type(s) �u
14,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1� No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[9 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
0 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[V No
❑ NA
ElNE
18.
Is there a lack of properly operating waste application equipment?
ElYes
[9 No
❑ NA
❑ NE
r�p h a v e- } o {a a .- s. i�o�c[
r�r�
A �
spots �,av c bce-,.s �cdL a.. ofL
1���•••�.�o�
,pLa�t��i.
t!drG CS Y�e�s ctar'-Yk
f"v Sprowt,• QajkJ o.rt� �1v��or-uv
Reviewer/Ins Ff. �g " _
Reviewer/inspector Name k_"
p / j�q:" _;
Phone: 9!O
�8� l.S�1fl
Reviewer/Inspector Signature:
Date:
G //a / o a
12128104 Continued

1. FaciligNumber: 8: — -i Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4 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
Q 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
(5a No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U 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
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IV 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
O 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
[P 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
[0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Addrhanal Cnmmeuts�andlor�,Drawings �',:r°f`.
"�'° ,19�,r '�s"',�'� �;<
NCOA A4rar.e►%I-d
`tr+.
���
— 10-3A"1-5ga4
12a&104

i
I
Type of Visit • Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit. 10 ` Time: �d
_.�.....,,_.._ - - - 0 NNot Operational Q Below Threshold
Gfermitted Q Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: . ---
Farms Name. t3'' .-._—
Owner Name: .__ _ �� 7'_4Ai J _ .- ._ Phone No: _.. 9/O - E 9zt
:Mailing Address: ___L _ L'd,►,...�,�_ /jla 1`f�, r /�� C , .r ., &L. 2 jqj
Fa&ity Contact: . _ . 7 h dma t & bS c Title:
OnsiteRepresentative: 7'6M"- ----Ma_HA",
Ceri ied Operator:---rAj2wxj...
Loon of Farm:
Phone No: 910 - 9
Integrator. l �r�SLZC, •
Operator Certification Number. ----4( 2/7
[Rhine ❑ Poultry ❑ Cattle ❑ Horse I.a6mde �• �' �� Lonotude F7u
L-E Z.
Swine S
P fion..p�y -
:Po on; Cattle;
eeder Layer
Dairy
Finish S / U Non -Layer
Non -Dairy
Wean
Feeder' Other
rlFarrow
Finish =
Xo Dedin 6pm cdty
BoarsW
�4 <,
:. Total SSL
RE1��itl�•pA>'f�e'/•�td �T�8U5 .
b�- �
� �,�... �?�A
Dikharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Rf-70
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 9No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes allo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 614o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): ; 7
12112103 Continued

r
Facffity Number: —sue
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ trees, severe erosion,
❑ Yes Ewo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ®-No
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 maintenanceJmzprovement? ❑ Yes 0,T 0
8. Does any part of the waste management system other than waste structures require maintenmoelimprovement? ❑ Yes [3,No
9. Do any stuctures lack adequate, gauged marloers with required maximum and minimum liquid level
❑Yes aIQo
elevation markings?
Waste Avolication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes UNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [9-No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type P3S Su
der���
13. Do the receiving crops differ with those designated ir1 the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MW6
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes UNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 9-Qo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑-K-
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Q No
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 ❑iqo
Air Quality representative immediately.
Case �"re+f. o f) Q/ {
i t/Nr� gr'lrus tt/ou.,� /a odit, 11o►TS r0
Gf .SOW
/1- y 4 -Vf 1. .4/ 1
r M[ pt SOr+aP
ReviewerAUwpector Name
❑ Final Notes
Reviewer/laspector Signature:
JV12/03
Date: 10,
Condnued

Facility Number: —fie Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 8Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/7P, c fists, de.-i�m , etc.) ❑ Yes Q-#o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UK&
g-20-9.7.3, a 1 &•.2I -> �2q .,b 2-.20-P 3•9'.71
24. Is facility not in compliance with any 4Xable setback criteria in effect at the time of design? ❑ Yes allo
25- Did the facility fail to have a actively certified operator in charge? ❑ Yes E3�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑NO
27. Did Reviewer/Inspector fail to discuss reviewli spection with on -site representative? ❑ Yes ONO
28. Does facility require a follow-up visit by same agency? ❑ Yes Milo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [moo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) [-Yes ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [nes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes &Io
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes Rio
34. Did the facility fail to calibrate waste application equipment? ❑ Yes LWo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ago'
❑-66e61aag [Trap- 4ek — ❑- - ❑
❑ ❑4dM1g1
12112103

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT3�
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
A -
Farm Name/Owner:
Mailing Address: —
County:
Integrator: Goh.
On Site Representative:
Physical Address/Locat
Type of Operation: Swine
Design Capacity:
DEM Certification Number:
Latitude: "
Time-
Phone:
Phone- Alfl - 5`92 - .32bZ
U
Poultry Cattle ter---- - -
Number of Animals on Site:_7- 7z
ACE DEM Certification Number: ACNEW
Longitude: "
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) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available f r spray. Yes or No Is the co er crop adequate? Yes or No
Crop(s) being utilized: � v � G
Does the facility meet SCS minimum setback criteria? 200 Feet fr m Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments:.if•Neeged.

-0-12--
_ Site Requires Immediate Attention: &_
Facility No.
494,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: zv , 1995
61
Time: Al
Farm Name/Owner:
Mailing Address: 396.4
County:_. -
Integrator: Phone:
On Site Representative: c Phone:
Physical Address/Location:
Type of Operation: Swine _� PouItry Cattle
Design Capacity: c.�_ Number of Animals on Site: -
DEM Certification Number: ACE DEM Certification Num ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Ye r No Actual Freeboard: Ft. Inches
Was any seepage observed from the la oon(s)? Yes or(T Was any erosion ob ed? Yes or Na
Is adequate land available for spray? Y or No Is the cover crop adequate? ke or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? es orro
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map BIue Line: Yes or Vo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or N& If Yes, Please Explain. -
Does the facility maintain adequate waste management recjgds (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?or No
Additional Comments:
Q.A-
Inspedo_r am
&c,,4 k4:,,
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z4 Z.G , 1995
Time: el
Farm Name/Owner: _ _. /N:A P — r+ :
Mailing Address: H _(Lim 3 V 6 - 04
7-7a�
1-3
County:_, 40LMAft N -�- - - - - - - ---
Integrator: _ A;4a. # a _ _ _ _ Phone:
On Site Representative: A4 -Woc < Phone:
Physical Address/Location:. S4m- 0 __
r
Type of Operation: Swine Poultry Cattle
Design Capacity: 1 Z Number of Animals on Site:
DEM Certification Number: ACE - DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h;bor
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) No Actual Freeboard: 2- Ft. Inches
Was any seepage observed from the
Is adequate land available for spray:
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelfi ? ies r No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or -
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orb If Yes, Please Explain.
Does the facility maintain adequate waste management s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye or No
A AA:►:. --1 n...........,.......
fig
. E
WI Lr , - j r. 1, 5 I __0
(s)? Yes ow as any erosion observed? Yes or No
)r No Is the cover crop adequate? Yes or No
- Z& -
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

i
?_7GI5T.=ATION =ORM FOR PsNVIAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or ecrual to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds tl^at are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant o 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DE'M. Please prim. clearly.
Farm Name: t 4&m n 5 1�T�►~t- �S t] !L _
T 19-�MS
Mai1._nc Address:
Councy:
ft N-PI5614._ Phone No._q
Owner (s) Name:
i7• A-S fAh-r T +S 77'e
_....
Manager (s) Name,
Lessee Name:
(4
:arm Location (Be
as specific as possible: road names,
direction,
milepost etc.
I I rA ; S -td A
O GF Z
%. 4221SIAJ
— T
+ -r
Laticude/Longitude
if known:
Design capacity of
animal w4sre management system (Nnmbe-
aid tvme
of conrined animal{s))
Average animal population on th- farm (Number and tyae of
animal {5)
-raised) _ Zb d _
Tee_ 06 SS
Year Production Began: '7 3 ASCS Tract No.: Z
Type of Waste Management System Used: lep. i ,1 a�
Acres Available for Land Apnlicatio� of Waste;
Owner (s) Signature (s) :e9'. DATE • _
DATE:
rk ke u s L67- 1 5 0� a���� +'►tee 1.5 � �.� fie
r 15 h 1'r J 21 7-O f J,� Ir' �"t �- C4 preX o� M. 'le S ) + r

XN7'MmT- VC ST3 ICU9U=MMT PZ.AN csR:_PIC..ALTION FOR NW14 OR E=A2MFM 7=14TS _.
Please ratu--= the c1+4tod fom to the Division of S:Mviro=aataZ )4A=ACamaat &r-
the ade---aas an the rovars4a side of thin Sorts.
Name of fay Pleaseprint)
Add. es s
P No
County:
ca :� location: Latitude and Long itude:JT1LI: �'r/�$°�� =' =e-,:ired) Also,
Please attach a copy of a county road map with location identified.
Type of operation (swine, layer, dairy, etc.)
Design capacity (n=her of animals) 114o
Average size of operation (12 month popu?acion avr_) :_7i-U
Average acreage needed for land application of waste (acres):_ R
as:aasaaaay�aaaaaaaaaasaeaasaa�aaaaaaaaaaasazaasaaayasaa=asaaaaa3asaaa=Tossaaaas
Tech==cal Sp.ciaiiat C4x-tificatiasY
As a technical specialist designated by the North Ca_-olina Sail and Water
Conservation Com,-.:1S54on pursuant to 15A NCAC 6F .0005, 1 cert'_fy that t e new or
expa..ded aaimal waste ma_iagement system as irstallea for the fa= name_ above
has a_-: animal waste management plan that meets the design, construction,
operation a:,d maincena_nce sta:,da;ds and spec_ficat_ors a: the Division. of
E_nvircmnental Management and the USDA -Soil Conse^ration. Se_^rice oral/o= t .e North
Carolina Soil and Water Conservation Conr.:ission pursuant to 15A NCAC 2H.0217 and
15A NCAC 6F .0001-.0005. The following e*ements and their corresponding minimum
c=itezia-haALa_beetechnicalverified by me or other designated technical specialists and
are included in the plan as applicable: mini-m.i.^Z separations (buffars) ; liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of laid for waste utilizat_cr. (or use of third party) ; access
or ownership of proper wasta application equipment; schedule for ti_+.ing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from sto =-gate; runoff events less severe tha.^s the 25-year, 24-houz
storm.
Name of Tech=.i l S eciaiist (P ease Print) r!
Affzl?at­ io. S-11 A °C_
Address (Agency) : a G 'nio Phone No. -1
Signature• a�83a-S pate: C�i,-��,-��
a��saeaa yvaaaa=vaaaaas=aasasee a:aaaaaasaaa�aaaae=aaaa3a�sa��a��aas=rasa
Owner/?;a.^ngar Ag=eazsanL
I (we) u-nderstand the ope_atwo a -rid maint•anasice procedures established in the
approved animal waste maziage_meZt plan for the fa_--i na_:.ed above a --id will implement
these =rocedures. I (we) Ir-now that ary additional expaxision to the existing
desig-: capacity of the waste treatment and storage system or constr•.:ctior. of new
facilities will require a new certification to :e su'cmit=ed to the Division. of
F.nvirornental *•.arage_ment before the new an_,.nals are stocked. I (we) also
understand that there must be no discharge of anizral waste from this system to
surface watars of the state either through a man-made conveyance or th=zugh
runoff from a storms event less severe than the 25-yea_•-, 24-hour stc=. The
approved plar. will be filed at the fa_-m and at the office of the local Soil a_nd
Water Conservations District. '
Na*r,a of % d�Qsr.:a= (Please Print) :�D[a� YYY-NGs 1�_Y.� � 1•} 5 - - --
Signa t�.4
Date: .2, -d:2
Name of vs -agar, if d_ffeze_nt from owner (Please print):
Signature: Date:
4^e: A change in land ownership requires notificat?on or a new certification.
(if the approved plan is changed) to be submitted to the Division of
Environzerital Management within 60 days of a title transfer.
DFi USE C9LY:A=ZW*

THoMas MAm�ws
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