820214_INSPECTIONS_20171231

NUH ! H LAHULiNA
Department of Environmental Qual

Type of Visit: (aTompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Dunne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a; c^} Departure Time: ( County: L,�P__ Region:
Farm Name: P'2 - +'Y`
Owner Name: dt / N' Y Ya m , n
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C4 n f C ) J „� �, Title: Phone:
Onsite Representative: Integrator: �<xnkc/
Certified Operator: Certification Number: ply/,�
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Y Design ,Current
Design Current
Swine Capraacty�op.
Wet Poiuiltiiry, Gapac�ityk
-1'0p.
Cattle -Capacity Pop.
y X
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dair
y Calf
Feeder to Finish I
Z4el b
klglzo
Dairy Heifer
Farrow to Wean
" DesI Current
Dry Cow
Farrow to Feeder
Eoult .
Ca aci Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
loll I
Turkeys
Other
Turkey Poults
p, Other
Other
u�dYLw[fm.�
:Lf19WY:Ilur:Aw�ux:.lua �-
QYNYOPteaxx:;:.iuufwY .s:.ur-xP---::- �. --__:W LI .:-:: I'w -_-
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)?
[:]Yes Pq-No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes C4-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: _ ) Date of Inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(allo
❑ 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: T /S %(v
Spillway?:
Designed Freeboard (in): Z2
Observed Freeboard (in): 3 / 37
32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
[X� 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
FNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[51-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
FNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ 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): }y
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 [3-No ❑ NA ❑ 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 [g.No ❑ NA ❑ NE
❑ Yes 0,No ❑ NA ❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 5�No ❑ NA ❑ NE
the appropriate box.
❑WUP —]Checklists ❑Design ❑Maps ❑Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2. 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 Ug-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - l Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [. No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes allo
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes O'No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 2-No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes [3-No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [3,No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [A -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
= r to' o Commeots'(refe q' est on'#() IExplain.any YES-answersandlor any addttonal recommendations or any other. catnmeoLs. %
U �drHw_ tngs of,faic_'ility, to tt explaen situations'(use=adaitionat pages`as necessary) i.C.� r t
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date. 3_ s;:.-
/
21412015

i ype or v ]sir: p Compliance Inspection V Operation Review U Structure Evaluation (> 'Technical Assistance
Reason for Visit: (Routine O Complaint Q Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: 7 Arrival Time: ,� Departure Time: LLL.J County: SAPY Region:
Farm Name: Owner Email:
Owner Name: �/l!d r� oc�/[��rig Phone:
Mailing Address:
Physical Address:
Facility Contact: _ LKA_4L<__ i,l( a Title: Phone:
Onsite Representative: (< Integrator: J VH, 4 1 eL61
Certified Operator: ( Certification Number: Xq 157
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Lim rent Design Current T Design Current
Swine C►apacity Pop. _ R'et Poultry Capacity Pop. -aftle Capacity Pop.
Wean to Finish
La er
DairyCow
DairyCalf
DairyHeifer
D Cow
Wean to Feeder
Feeder to Finish L
Farrow to Wean
J
Non -Layer
3 _
` Design Current
Dr,. �P.oulti. Ca aci Po
Farrow to Feeder
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke ys
I 113eef Brood Cow
IL
Other
Other
Turke - Poults
Other
Discharges and Stream Impacts
l . 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?
Page I of 3
Lk._. - . . . I_.u....
❑ Yes [CPi(5­ ❑ NA [] NE
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Ea -No
❑ Yes LTNo
NA ❑ NE
[ 'NA ❑ NE
['NA ❑ NE
❑NA ❑NE
❑NA ❑NE
21412015 Continued

IFaciUty Number: g- f J4 Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3-m° ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No KA ❑ NE
Structure 1
Identifier: r4(
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
15 16 17_ /r t f
Designed Freeboard (in):
Observed Freeboard (in): 33 $G 0q7 3 a
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
A 60
❑ Yes O'No
❑ Yes eNo
❑NA ❑NE
❑ NA ❑ NE
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 [ 1No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes dNo ❑ 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 Ea 1Go ❑ 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): 6Cct'wl A_ J G —� �ijf�l-U/
13. Soil Type(s): /VO '60 (,.)e .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E;rNo ❑ NA ❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application`?
18. Is there a lack of properly operating waste application equipment?
0 Yes [ErNo ❑ NA ❑ NE
❑ Yes [21No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E;j-No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WNO
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

t
--7
Facility Number: Lr, ok _ a jDate of Inspection:
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Rl to ❑ NA ❑ NE
25 "Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [q*o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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 [31 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ga'Po ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
i
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ea"Ro
❑ 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
�VO
❑ 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
0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VfNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
El"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑"No
❑ NA
❑ NE
Reviewer/Inspector Signatuz
Page 3 of 3
Date:
23 (7
21412015

(Type of Visit: U�ompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: &k011tine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: l�l�'!'t l rrival Time: :op Departure Time: County:
Farm Name: Fa4n,L OwnEmail:�
Owner Name: Cit 4-t ripk >` "^' rt,OY Phone:
Mailing Address:
Physical Address: / �I
Facility Contact: j Za+ti�l(�Gt� CVtA�[& s Title: Phone:
Onsite Representative:
C(
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region: ► "`-v
Certification Number: p2((1 f J
Certification Number: l 7[ f "
Longitude:
Design Current
DesigaCnrreat
Design Current
Swine
Capacity Pop.
Wet Poultry. -" Capop:
Cattle Capacity Pop.
can to to Finish
Wean to Feeder
Feeder to Finish
Zq a73 V
La er
Non -La er
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Designr , Current
D Cow
Farrow to Feeder
D . P.oulCa aci Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
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)?
[] Yes Ej'% ❑ NA ❑ NE
❑ Yes
❑ No
[3,1�A
❑ NE
❑ Yes
❑ No
[RI�A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No dNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E!fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is -storage -capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R2-Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No U]�<A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ [ _ (7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 O G 31 7 7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
9_S 3 t
❑ Yes [Z w
❑ Yes [k90
❑ NA ❑ NE
❑ NA ❑ NE
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?
es
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[54o
❑ 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
[;I<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E N ❑ 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): &-2- c�'' � ✓ CT _
13. Soil Type(s): 60 OJ W k $ t V4'+
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes [2"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes C3 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 ff No [] NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [/7No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ 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 q 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 [f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes E3"'�No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ET150
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes QJ'346
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 g5,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes to 1xo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
�o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[/] N
❑ 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
la:J o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
EnNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
[;KVo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�Ko
❑ NA ❑ NE
Comments (refer to°question #): Explain any YES'answers and/or any additional recommendations -or_ any _other comments
Use drawings of fncilityto better explain situations'( use additional pages as necessary).
Ca(C-
Qv_�e
3,-7 3
�6 7
G{` 3 ry
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: k 33-3
Date: i1M/
21412014

IType of Visit: (DR61mpliance Inspection Q Operation Review Q Structure Evaluation () Technical Assistance I
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: - Region:
Farm Name: 5 &) ] (V Owner Email:
Owner Name: �4y+�' �� �j6 Phone:
Mailing Address:
Facility Contact:
�L40 i r_ lit Ut 4►•�S Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: %V 9
Certification Number:
Certification Number:
Longitude:
Design @urrent
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to FeederEUKI—jayer
Da' Calf
Feeder to Finish
{�
Da' Heifer
Farrow to Wean
De ign Current
D , P.oul &a aci P,o
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
NJ Other
10ther
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EJ�M❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
[c] P3A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E]-N
❑ 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
EEr<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3'flo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes EfNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214,12014 Continued

Facili Number: U V- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 21A ❑ NE
ctdure 1 Stru tore Stru a Structure 4 Struc e 5 Stru tore 6
Identifier: O f l4 e
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
(❑-Ko
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
To
❑ 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
�Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[llN
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
D Yes
EJ/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 Drift ❑ Application Outside of Approved Area
Wind
12. Crop Type(s): 13 q C^ C)
13. Soil Type(s): �� l Kr••i (4 )a
—
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[9.1G'o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E!rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[TNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-'No
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
[3No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
E2rl�r
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection:
A Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®'1Qo❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ef 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:
2& Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L_I o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
12'No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[D Yes
E] 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
[:�M
❑ 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
ErNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo
[] NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA
❑ NE
Comments (refer to question-ft Explain any YES answers andlor:any additional recommendations or any other comments
r
Use drawin s of facili to better explain situations use additionalA a es"as necessa
g h' : P ( P g . ry).
SL,..c �Le 7(
s
9—
q q 7-z;,
q,5 74
c d "1 +190r
k.-') e_ O+A 0_1
Reviewer/Inspector Name: AlN t`
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L. 3 ` 33
Date:
21412014

hype of Visit: fc:rUompliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: �utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: N-WT__1
Departure Time: County:
Farm Name:
J� j
+fV1,
Owner Email:
Owner Name:
ey,r' '
91Kt �+^i
_ Phone:
Mailing Address:
Physical Address:
Facility Contact: V-ov q f .e- b2 1 V Title: Phone:
�/J
Onsite Representative: G ( Integrator., 1' E
Certified Operator: it Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region: Rno
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle .: Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
�,
Dai Cow
Dai Calf
Feeder to Finish
ZZ't
"'
Da'iry Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr'KP,oult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Gilts
La ers
on -Layers
Beef Stocker
Beef Feeder
Boars
Pul lets
Turke s
Beef Brood Cow
Other
Turke 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
Er A
❑ NE
❑ Yes
[:]No
[;3'NA
❑ NE
[:]Yes
[-]No
[jTNA
❑ NE
[]Yes
[rNo
❑ NA
❑ NE
[:]Yes
R�rNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: I Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [2-N0C ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3� �' Z �7 V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L2' ❑ 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 [T No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Flo ❑ 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 [JJNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [E'Iio ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes <o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift
❑ Application Outside Approved Area
np❑
12. Crop Type(s): J Sv
//of
13. Soil Type(s): t
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes �o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[—]Yes Lt=J i10
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E .1�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
Q'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [`No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EJ'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EKO ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

.... .44 .= r-+ . d a v �e ' 4 a;
• k

Facili Number:tD Date of Inspection:
24+Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FRVo ❑ 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 l;.JJ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesF7f-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
Comments (ref&46-ques66114): EapWn'any YES;answers�aud/or.any additional recomment
r
'RVA,e_ &.,141
11
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [3'g ❑ NA ❑ NE
❑ Yes 21No ❑ NA ❑ NE
[-]Yes <0 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [" No
[:]Yes F-Ko
❑ Yes [�o
P
qC 0
3'(7
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
mments: ...i
-S,b —0.uo
-- 17 34
t« V Phone: l to `[ 3 3 3 '-f 3 I
Date
214/1014

type of visit: QWCompliance inspection V operation Keview V Structure Evaluation V I ectinical Assistance
Reason for Visit: [Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �-' Arrival Time: Departure Time: ± County: Region: rAD
Farm Name: Owner Email:
Owner Name: j�- �L,»g(�} Phone:
Mailing Address:
Physical Address:
Facility Contact: ?drt114 �,��\�p�{��j Title:
Onsite Representative: SAm
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: MQR,06Tf2��0
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
C*urrent
Pap.
«et Poultry
©esign
Capacity
C•nrrent
Pop.
Design Curren#
C►►attic Capacity Pop.
Wean to Finish
La er
]Non -Layer
DairyCow
Dai Calf
Wean to Feeder
Feeder to Finish
a
D , Po.ul_ ,
Layers
Design
Ca acity
Current
P,a ,
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
EF7Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Qther
01 Other
Turkeys
Turke Pouets
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 W No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes No
[:]Yes No
M NA ❑ NE
®NA ❑NE
RX NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Fftili i'Fumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No M NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � \�A t \S #A i Lp 30 1-1 _# IS )4 1't
Spillway?:
Designed Freeboard (in):� j Cti
Observed Freeboard (in): ` )6 yp '50
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M 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 [I 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 r7 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes (4 No [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® 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 [N No ❑ NA D 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 ❑ ApplicationOutsideof Approved Area
12. Crop Type(s): i nI,STRN V-0-M V0 q r3R�5b1 i�lA�t 1 3. G 0. , w\
13. Soil Type(s): Nn —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []t No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
[DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[& No
❑ NA
❑ NE
Ree uired 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
171 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 DD 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 W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Co No ❑ 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 Co No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes g 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 K] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes GQ No ❑ NA ❑ NE
❑ Yes 6Q No ❑ NA ❑ NE
[:]Yes NJ No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
4 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
[ No
❑ NA
❑ NE
Comments (refer to question #): Explain anyXESanswers and/or any additional recommendations or any other comments:
Use,drawings s of facility to better explain situationsluse additional pages as necessary). z r _
;"•.
k
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
S Phone: %0.30C14 _UC694
Date:
21412011

type ur visa: WUompuance rnspecnon v uperanon xevrew U atructure 1 vatuanon V i eenntcai assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ' l Arrival Time: ;Q9 Departure Timer County: SO Region:
Farm Name: 13n6SoQer► rI D tit G• Owner Email:
Owner Name: _Qp(- W� �yJa.�r1 _ Phone:
Mailing Address:
Physical Address:
Facility Contact: ftI rke dig ff,,S Title:
Onsite Representative: N
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: Integrator: 1r
W L.-
Certification Number:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes No ❑ NA ❑ NE
❑Yes ❑No
❑ Yes ❑ No
NA ❑ NE
T NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

I:acili Number: - Date of Ins ection: la 24
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J A �3 1 q
Spillway?:
Designed Freeboard (in):
14
Observed Freeboard (in): YO y / U LI �7^ os/
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
5 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)
T
9. Does any part of the waste management system other than the waste structures require
[] Yes
W No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4] 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�A�pprooved Area
12. Crop Type(s): G Q� &4R 5 640, 3m, "3 _ 0 (Iw 5 'f UL;J r&91-11QWs
13. Soil Type(s): jPfp /1, ;Vqt?, fV0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
T\ No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ 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 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Wacitity dumber: JDateof Inspection: I
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. r
❑ 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 IF No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes }�i No ❑ NA ❑ NE
Other Issues
2& 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?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
Ir
If yes, contact a regional Air Quality representative immediately.
36. 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 [p No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes EP No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
omments.mments refer to uestion # • Explain an YES answers and/or any, additional recommendations or.an other c
Fe'drawin{soffscili
to better eaPlain situations use additional a es �s necess
g - P { pages . ary).
9-e" reUl eur-A (o f till 1.
C"* v1-SfL*— o'
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /C
2/4/2011

j
Type of Visit 40 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint () Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Arrival "Time: Departure Time: j County: S-4141PsV J Region: Peo
'Wain 1 M PLem'Ace Owner Email:
RD64 IA), SiAJCI.t Phone:
Physical Address:
Facility Contact: Title:
H
Onsite Representative:
Certified Operator: A
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 2
Back-up Certification Number:
Location of Farm: Latitude: [= n = i = u Longitude: ❑ o E:J' = "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
❑ La er
iry Cow
❑ an to Feeder
on -Layer
iry Calf
Feeder to Finish
iry Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑Pullets
ues
❑ Beef Brood CoAJ
❑ Turkeys
Other
❑ Other
❑ Turkey Pouets
❑ I INttmber
Structures:
Other
of
Discharges & Stream Impacts
I . Is any discharge observed from any pan 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 [7bNo ❑ NA ❑ NE
❑ Yes
❑ No
(A NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
CtNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: g Date of Inspection r( O
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 [I NE
Struc ure 1 Struct re 2 Stru ure 3 Structure 4 Structure 5 S1ttru lure 6
Identifier: s
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
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes]
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
ip No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
{p] No
❑ NA
❑ NE
maintenance or improvement?
ll
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
`f' No
❑ NA
❑ NE
maintenance/improvement?
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ 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 Soi
❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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
[I NA ❑NE
�No ❑ NA ❑ NE
No El NA ❑NE
l� No ❑ NA ❑ NE
�]No El NA ❑NE
[D No ❑ NA ❑ NE
Reviewer/Inspector Name _� � Phone: 9/0
Reviewer/Inspector Signature: Date:
Page 2 of 3 1212 /0 Continued

Facilfty Number: B�L' Date of Inspection
Required Records & Documents 7
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other P #V
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers I Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drai ngs: w
❑ Yes
No
❑ NA
❑ NE
❑ Yes
9No
P NA
❑ NE
❑ Yes
CPNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ 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 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ denied Access
Date of Visit: Arrival Time: : !aD Departure Time:
Farm Name: l Own
County: Region:r�
er Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
t.(
Onsite Representative: r' I
Certified Operator:
Back-up Operator:
/�' Phone No:
Integrator: " : &
Operator Certification Number: �7
Back-up Certification Number:
Location of Farm: Latitude: = e =1 = v Longitude: = ° =' E� W
Design Current Design
Swine Capacity Population Wet Poultry Capacit—Yap
Current
pulation
Design Current
Cattle C►apacity Population
❑ Wean to Finish
I
I
I0 Layer
❑ Dairy Cow
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
ILI Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
Dry Poultry
El Dry Cow
Farrow to Feeder
❑ Farrow to Finish
Discharges &Stream Impacts
1. is any discharge observed from any part of the operation?
El Yes
EP No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
(E] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
P 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)
El Yes
❑ No
rpNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
E@ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
%] No
❑ NA
❑ NE
other than from a discharge?
11/18/04
Continued

=` Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No E�bNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 3
1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 724
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
'a No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
PPNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;5 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
91 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop WindoF ❑ Evideneg-of Wind Drift ❑ Application Outside
of Area
12. Crop type(s
13. Soil type(s) JJdr-��k
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
53 No
❑ NA
❑ NE
Comments (refer to question #) Explain anyYES 'answers and/or any recommendations or any�othercomments.
Use drawings of facility to better egglain situations. (use additional pages as necessary):
I Reviewer/Inspector Namec np� �,j ;, r. Phone: (0 33r33ea I
1I Reviewer/Inspector Signature: Date: ( L
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes k] No [I NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
El NA
I--]NE
the appropriate box. ElWUp El Checklists El Design El maps El 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 El
E�l
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
ML
❑ 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?
El Yes
No
NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
(P NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes i' 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
[j3No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
to No
❑ NA ❑ NE
12128104

Facility Number $�
- Division of Water Quality V1,
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit I�Xompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
ll _ N
Date of Visit: l Arrival `rime: Departure Time: Coun Region:
Farm Name: ISLJI J► V—QLV M I I nC Owner Email:
Owner Name: 6 ''c w 5 W� Phone:
Mailing Address:
Phvsical Address:
Facility Contact: + k� t ` Title: LV ' Phone No: G 08
Onsite Representative: _ ► #_t`j� 5 Integrator:
Certified Operator: lsu% U t CA0, Operator Certification Number: 2�0 r
Back-up Operator: ' `+ Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = « Longitude: = ° = ` = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
10 Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean -1 a
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke PouIts
❑ 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
Capacity Populatiou
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures ELI
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 "'K No ❑ NA ❑ NE
❑ Yes
❑ No
�dNA
❑ NE
❑ Yes
❑ No
J�j NA
❑ NE
El Yes
El No �NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
b No
❑ NA
❑ NE
12128104
Continued

F'aciUty Number: a —
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): 1-7
Observed Freeboard (in): 112-3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,a�,,
6. Are there structures on -site which are not properly addressed and/or managed El Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes rVl ElNA ElNE
(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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &,,/ rn— -4 , � &,, o is , Sau — W
13. Soil type(s)
Yh
14. Do the receiving crops dit er from those designated in the CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
bNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�_7 - C w,4;nuc Per
tie Qre-0S -
Reviewer/Inspector Name
19 S6r-d;1 il I W J'- -Y) W
'\� It
Reviewer/Inspector Signature:
Date: LL
f17i1oin.r
Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PqNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [)"'C'No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
2 L
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes W 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
CoNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
;3jSNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
§d No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No,NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
lt�j4Vo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
[I NA
[I 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/2"4

Facility No. o` �� Time In Time Out Date
Farm Name _ AA Sk-)a
Owner ';' 4 SIX —
Operator VI '.Vki -: i CAoil'
Back-up V)O
Integrator AYq
Site Rep ;_77
No. a 6o1
No.
COC _�� Circle: Gener I or NPDES
P
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
eed - Fini
Gilts / Boars
ar - can
Others
N.
FREEBOARD: Design
Observed
Crop Yield V, -11 �q
Rain Gauge
Soil Test a
Weekly Freeboard
Wettable Acres
Daily Rainfall
j `'
'7. 14 , 3
Sludge Su j 0 ,O� -3 $5 7 - G .6
Calibrations P
Waste Transfers
Rain Bre
PLAT`_
1-in Inspections
Spray/Freeboard Drop Mr).ir ftNLr �►..�. Qa,�, IN." M o-1
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
j a3 o,,�•I.,t-gz.z 3.yv4 3 j
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
IA
pn
tt�
r
r

O Division of Water Quality
Facility Number 2 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit *Compliance Inspection O Operation Review E Structure Evaluation Q Technical Assistance
Reason for Visit ®Routine o Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival
Time:
3 %3 Departure Time: .�� County:-s�^Psa � Region:
Farm Name: -�1F- r 990 Owner Email:
�D -L.s�., at , Phone:
Owner Name: Mailing Address: _ A�"�✓/��,�
Physical Address:
Facility Contact: e [ [ OW15 Title: Phone No:
.N
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede:
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o =, Longitude: = ° 0 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -Layer
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey PouIts
❑ Other
DischarVs & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
_
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes'. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
f
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes
❑ No
� NA
❑ NE
❑ Yes
[:]No
f NA
❑ NE
[§ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EpNo
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
12128104 Continued

Facility Number: a—a�
Date of inspection #E
Waste Collection & Treatment
�''
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IF No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ffij 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 V 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 �0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes IF No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1p No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
Crop Window j❑ Evidenncce of Wind Drift ❑\Application OutsideofArea
kaZ�L
12. Crop type(s) df1LI� Vfl . bCdJru JiYtQ D'KL,�Qc. 1, IJ r `O"'h —
13. Soil type(s) Lt�a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
t5No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
i S. Is there a lack of properly operating waste application equipment?
❑ Yes
19 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: Q�
Date:
12128104
Continued

Facility Number: — Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ( No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment? ❑ Yes ;9 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IM No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
( No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
[[
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 I2128104

1414
Type of Visit WCom Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0Routine O Complaint 0 Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: $ [ 5� Ob Arrival Time: Departure Time: County: Region:
Farm Name: �! }=A`��n- O '� Owner Email:
Owner Name: 'T Phone:
Mailing Address:
Physical Address:
Facility Contact: Wk
Onsite Representative: J
Certified Operator: �' s- ` --
Back-up Operator:
AV
Title: Phone No: 9 no
Integrator: U Y
muI 5 Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F-1 0 01 = N Longitude: 0 0 = & =
As
Design Current Design Current
Swine Capacity Population Wet Poultry, Capacity Population
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Finish ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
1-1 Turkeys
Other El Turkey Points
❑ Other ❑ Other
❑ DairyCalf
❑ DairyHeifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
ElBeef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges
❑ Wean to Feeder
ederto Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
&Stream Impacts
1.
is any discharge observed from any part of the operation?
El Yes
M.
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
�$A
❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑Yes
❑ No�,WA
❑ 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
_;�JNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
�oo
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
N
❑ NA
❑ NE
other than From a discharge'?
Page 1 of 3
I2/28/04
Continued

Facility Number: a� Date of Inspection L a115 �Qb�
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 )ZNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): N d9
Observed Freeboard (in): 33 n `7 2 7 "
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes l to ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed Eyeso ❑ NA ElNE
through a waste management or closure plan? 53�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? X Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes *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 4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 93o ❑ NA ❑ NE
maintenance/improvement?
] 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I�Ro ❑ 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 receiv
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes EbNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes';16Vo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
re� vn5 - �a� 5�,� itl-ud �a s
Reviewer/Inspector Name � jLj j Phone: `` 0 4,-)7)
Reviewer/Inspector Signature: Date: �p
Page 2 of-3 12128104 Continued

Facility Number: — Date of Inspection 5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ V" D Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes *No
❑ Ye"�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ) Io ❑ 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 V
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XIo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OL ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Nio ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes q Io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes �"o ❑ NA [IN I,
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes kVo
❑ NA ❑ NE
❑ Yes *o
❑ NA ❑ NE
❑ Yes �1No
❑ NA ❑ NE
❑ Yes 2PNo
❑ NA ❑ NE
❑ Yes ANo
❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
Additional Comments and/or Drawin s.
Page 3 of 3 12128104

Facility No :'�a - a Time In Time Out 1 Date
Farm Name , Integrator _k _
Owner - Site Rep" Qmmw:s
Operator'6o6 t .c �� No.
Back-up
COC
Circle: General
Loll
No. _—
PDES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
- finis
p
Gilts I Boars
Farrow -- Wean
Others
REEBOARD: Design
R'NSludge Survey
Crop Yield
Rain Gauge O
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Observed
Calibration/GPM 1
Waste Transfers
Rain Breaker
PLAT Wettable Acres
Daily Rainfall �� 1-in Inspections L�
120 min Inspections
Waste Analysis:
Date Ni rogen }
(dj-r i.Z *57 zs Z Z
5 /re 2-1 _z . - 1.7 2.2- r.B
Date Nitrogen (N)
�7 ►.5 z, T /3,

Type of Visit AD Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: D Arrival Time: —
Departure �)
re Time: � County: Region:
Farm Name: � '�' rTUG rstit . se- - Owner Email:
Owner Name: _f2oLeA� vu j Phone:
Mailing Address: r / -,, P SW
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: c vVt prv`S
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: ❑ ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
11 ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys.
❑ Turke Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (I1'yes, notify DWQ)
c- What is the estimated volume that reached waters of the State (gallons)? -
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes] No ❑ NA ❑ NE
❑ Yes
❑ No
V NA
❑ NE
❑ Yes
❑ No
1 NA
❑ NE
�tNA
❑ NE
❑ Yes
❑ No
❑ Yes
�kNo
❑ NA
❑ NE
❑ Yes
)KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: � 5 — / (
Date of Inspection 5 y
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V[No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure.) Structures.- Structure 3 � Structur�4- Structure 5#j� Structure 6•�'�
LIdentifier: 4 Z ?rs-At r 1- e 3' ' S 'goe
Spillway?: - a1 „ A0 Piz He) /n4D
Designed Freeboard (in): ' rj
Observed Freeboard (in): :� '� 0 �. p 1,13
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes TNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [. No ❑ NA ❑ NE
i
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) r
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 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Totai Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
2
12. Crop type(s) „tt nt C s a G -
i cz,
13. Soil type(s) Q ._ A �K >
r
14. Do the receiving crops differ fr Z Ese designate-d5in the CAWMP? ❑ Yes ANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ANo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
[INA ElNE
17. Does the facility lack adequate acreage for land application? ElYesro
o
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 9No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary.
Reviewer/Inspector Name fp _ Phone: n - p. -I.
Reviewer/Inspector Signature: w Date:
12128104
Continued

Facility Number: �j' — t( Date of Inspection-'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes [:]No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists P Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�(No ❑ NA ❑ NE
❑ Waste Applicatiod❑ Weekly Freeboard❑ Waste Analysirs"' ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfalr ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26, Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewerllnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
10j No
❑ NA
ElNE
❑ Yes
�?No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
59 No
❑ NA
❑ NE
❑Yes
[0No
[I NA
ONE
❑ Yes F No ❑ NA ❑ NE
❑ Yes *o ❑ NA ❑ NE
❑ Yes )?[No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
P'No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
"li itional Ciiinmedts.and/or Drawings:
la clea-r zwoo"r'
' y ` .]JV �.:..� iiL1i%_ V"e'�' j jrd •"tif j i'. ✓LC'L�-.rYYtC .G '�. C7�.� '4�
12128104

t
Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of \-isit: Time: = fly
Facility Number
Not Operational 130ow Threshold
® Permitted ® Certified © Conditionally Certified [] Registered pate Last Operated or Above Threshold:
Farm Name: —e,,6 Ogg For,,.. L+G Count•: 5Gy+ SdtJ FRS
Owner Name:
Mailing Address:
Facilit Contact:
Title:
Onsite Representative: r ,4 4•
Certified Operator: 4 _� s r, e 0-
Location of Farm:
Phone No:
Phonel No:
Integrator: m k r 12 n 4- r s
Operator Certification Number: FA a j 14
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 9 ~ Longitude ' 1 OK
Design Current
Design Current Design Current
Swine Capacity Po ulat on
Poultry
Capacity Population Cattle Capacity Po elation
❑ Wean to Feeder
ID Laver
I
I
I
JE3 Dairy
© Feeder to Finish
❑ Non -Laver
I
I
JE3 Non -Dairy
❑ Farrow to Wean
❑ Farrow• to Feder
10Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ goy
Total SSLW
Number of Lagoons �J ❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is anv discharge observed from any past of the operation? ❑yes 0 No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is obsm7ed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes. notif., DWQ) �] yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin? N
d. Does discharge bypass a lagoon system? (If yes, notifi, DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J�3 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier. c7 J g 7 9
Freeboard (inches): %Q " 3 8 " �y '� _ 31
05IV3101 Continued

F-acility Number: Date of Inspection J/ a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® 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 maintenancelimprovement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste ADDlicatian
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Pon/d�ing ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type /7c—rr AWc, /yap;[ f sr.aF1/Gra 1 SQS$L_ra^s-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes ®No
16. Is there a lack of adequate waste application equipment? ❑ Yes (9 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [:]Yes ® No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air duality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
/- oi' -0, SrGIbo,, b{-.-Ai 1,-v _` q_,YC SPSc�-S
Or VV" .� la`l00 ila} woody raTaaYl rCrc�a
t c io4 �r G r, 0,
Reviewer/InspectorName
Reviewer/Inspector Signature. ^c2� Date.
12/12/0.7
Continued

'acility.Number: &� —.;2 )k 1 Date of Inspection o7 O
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NTDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3 L If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ® No
❑ Yes ® No
❑ Yes R( No
❑ Yes ® No
❑ Yes [2 No
❑ Yes VNo
❑ Yes (p No
❑ Yes F No
❑ Yes g[No
M'Yes ❑ No
❑ Yes [�INo
❑ Yes P9 No
❑ Yes EO No
❑ Yes ® No
❑ Yes ® No
12112103

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
j
Time: ! l%', �5—d
Farm Name/Owner: /90P J104
Mailing Address: 1 ?-4 HfNR A4 -,W L_0
County:
Integrator:
On Site Representative: L E-
Physical Address/Location: 1740 _ 3 A1: L
Phone:
M
Type of Operation: Swine tX Poultry Cattle
Design Capacity: Number of Animals on Site:._I7
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficie
(approximately I Foot + 7 inches) yet or No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? es or No
Crop(s) being utilized: C'l
3- 7?77
nt freeboard of I Foot + 25 year 24 hour storm event
Actual Freeboard: 3 Ft. Inches
Yes or 10 Was any erosion observed? Yes otNg
Is the coved crop adequate? 0or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ye or No
100 Feet from Wells? es r 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 Bluetine: Yes or(g>
Is animal waste discharged into water of tjT state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (9 or No
Additional Comments:
` Lx) S --
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

JUL 14 ' SS 11 : 46PM
IgCIRTH CAROLVM DZPARTNENS DF ENv1R0bMG=, BEAT•TH & NATURAL RFSOURCES
DIVISION OF ZWIRs 02E1TAL MANAGMEEN`P
Fayetteville Regional Office
Animal operation Coxpliance I specti= Form
�"!NSP£LTI 9TS?=« FAR.�i @SSA.
-i. � ay s.YMY•.N.:�...�n.•.r....�.... �J�4.-w+w... �,
..'� .:... � . aSA]'ZZZN{'-.:>7�DDRF.55 �-.€�. •• �'�;;
.� > ' F
•>•;•:.....� �.gACIiI3'Y•-NLJ?�F.�t. _
44 QpADVjA0Ar1 C, 26 a E93 - -7777
All_questio= answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Mimal aoeration Tlrpe
Horses, cattle , poultry, or sheep
SECTION II
Y I H I CoMm2as
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid Waste
system)I •
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a ANIls_AL
TASTE 1riArAG7MENr_ PI.AtQ.
5. Does this facility maintain was4e management
records (Volumes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighhcring houses,
Wells, etc?

jUL 14 ' S:J 11i-
' • _. ,tSEL�'ID*7 III
i
Field Site Management
1. Is animal waste stockpiled or lagoon
construction withiai 100 ft. of a DSGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated Within 25 ft. of a DSGS Map
Blue Line Stream?
3. Does this facility bane adequate acreage
on which to apply the waste?
4. Does the land apglication'site have a
cover crop in accordance with the
=TiFICATION PLAN?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man -wade devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
- (BALD) of the approved CER�I�.g�?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
S. Is the general condition of this CAFO facility,
including management and alteration,
satisfactory?
Sr=ION ry
Cam -Rents