820237_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

I ype of Visit: QrUompliance Inspection V Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: WRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: r 5 _ County: W Region T-70'Z J
Farm Name: L Owner Email:
Owner Name: �, klt,rr izd J�S _ Phone:
Mailing Address:
Physical Address:
Facility Contact: (_ r,��^�� 5 �a� ✓�(�l�Gt�- Title:
Onsite Representative: l
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:r
Certification Number: 1$ 3 Y 7 _
Certification Number:
Longitude:
E;0Nnurent
Swine ity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Cattle Capacity Pop.
Dai Cow
Dai Calf
I
Wean to Feeder
Non -Layer
Feeder to Finish p
Farrow to Wean
Farrow to Feeder
Design C*urrent
D , Poultr. Ca aci P,o ,
La ers
Non -La ers
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
rOne
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes L],Nrt ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No A[31I A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No E2�KA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No �NA ❑ NE
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �#o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [21"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 [9-lea- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑'lqo— ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [a o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes B'go ❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C;3<o ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t� e, It "ke(.J,a Sb 0
❑ NE
13. Soil Type(s): 4 ot-tj 6L,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V],No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�lo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[D" No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2rl�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
U No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo
❑ 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 [%f No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q-No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 0-go ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
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)
to ❑ NA ❑ NE
�Ko
❑ NA ❑ NE
❑ Yes [: iO ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes DNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
LH"""'
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E]No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Pj'�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ef No
❑ NA
❑ NE
Commenis l ti 1 Y y � noas or an otner comments. r u o atn an n ers,an or an a on recommen y_ F
Use drawn ofkfac tobetterezplam sittiafions':{use.addtbonal pages;.`/`
x: =x ...
gs dity as necessary) e
c4( qro- &q-Wc
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: to
Date: "
21412015

trAg J1 A8Q1I,
Type of Visit: IZ'C-o/mpliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: •L3 Routine Q Complaint O Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: I N6kl I Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: k�[ Phone:
Mailing Address:
Physical Address:
Facility Contact: • -G (AA �� i j4r�(,� l Title:
Onsite Representative:
Certified Operator: If l
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: ey"'C4,t
Certification Number: jb 3�7
Certification Number:
Longitude:
Design Current::.X
esign Currents
Design Current
:
Ca aci Po *Wetlt,p ty _ p �Dattle Capacity Pop.
• P h P acl i'o C
Weaneto Finish
At-
Non -La er
�JF
Design Current
ai Cow
DairyCalf
Dairy Heifer
Dry Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
�' 4 <"DiT—V uIt"- 73, ac] Po - _- '
Non -Dairy
Farrow to Finish
- Layers iY
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Pullets_
Beef Brood Cow
Turkeys
Joeoars
er
Turke Poults
ther
LjOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
1 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 pJtI6- ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes [:J�o
❑ Yes EETNo
[fj'NA [] NE
Q NA ❑ NI
eNA
❑ NE
❑ NA
[] NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: •<.
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ka'<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [T No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes EJONo ❑ 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 LEJ�Jo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes F!(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 [2(No
❑ NA
❑ NE
maintenance or improvement?
4
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [A No
[DNA
❑ 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):
ev A'ag& S
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [3-No
❑ Yes PNo
❑ Yes [2 90
❑NA ❑NE
DNA ❑NE
❑NA ❑NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
0 Yes
VNo
[DNA
❑ NE
❑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
n
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ?/No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? v ❑ Yes [�io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [!TN�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [::]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [30No ❑ NA ❑ NE
❑ Yes [2'No ❑ NA ❑ NE
❑ Yes [:31No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [?,No
❑ Yes [j'No
❑ Yes [3"No
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
Reviewer/inspector Signature: uM.�o�/j Date:
Page 3 of 3 /4/1015

'At
101
Type of Visit: (5 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (2f Routine O Complaint Q FoRow-up O Referral O Emergency O Othecr+ O Denied Access
Date of Visit: � Arrival Time: �D Departure Time: 6� County: V Region:
Farm Name: �~ Owner Email:
Owner Name: ka r t`G 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: , QLnA' c^jou t•{L Title: Phone:
Onsite Representative: t Integrator: _ 10eOr e-
Certified Operator: C Certification Number: if
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desigu Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
I
ILayer
I
I
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Dairy Heifer
Dry Cow
Feeder to Finish
Farrow to Wean
._. ., .
-
V.. I
'Dg:Fonl Ca aci
P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
JLayers
Beef Stocker
I Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Ottier
Turkeys
Turkey Poults
MLLOther
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[]gQ<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[2,NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[f" NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[3NA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�:rNo
❑ NA
❑ NE
3, Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Faeflity Number: a - 2 Date of Inspection: ;XAV
Waste Collection & Treatment
41s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
2' A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
L1Go
❑ 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
[4lo
❑ 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
hio
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3-fJo
❑ NA
❑ NE
maintenance or improvement?
I
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [�KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): SG
13, Soil Type(s): l�J�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes [a'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ 3 No ❑ NA ❑ NE
❑ Yes [3No ❑ 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
[3"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
0No
❑ 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
E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ 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 a ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g-1'do ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [@.Na ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Ergo ❑ 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 [3-No ❑ NA [] NE
❑ Yes ®'No ❑ NA ❑ NE
❑ Yes Q'llo ❑ NA ❑ NE
❑ Yes L]Ao ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 0 Yes La'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes LZNo ❑ NA ❑ NE
Comments (refer to question f Eaplaut any YES answers and/or any additional recommendations orany other commA.entsi��
Use drawings of facility'to better explati situations (use additional pages as necessary x
(3", S _ T-eA9_- If § - 3 7- P- S_-"s
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 'W 3'3
Date: 1 t`YA
2/4/2 l4

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q,"utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:1 1,10haw Departure Time: A County: Region:
Farm Name: - L Owner Email:
Owner Name: , ! 0 a 'S Phone:
Mailing Address:
Physical Address:
Facility Contact: (. ,± I s l7 4✓'Gy_ �ii' ` Title: Phone:
Onsite Representative: integrator:
Certified Operator: Certification Number: f n / 7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
I
I
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [51T63 ❑ NA ❑ NE
❑ Yes [a'Ro ❑ NA ❑ NE
[:]Yes [alo ❑ NA ❑ NE
❑ Yes [ENo ❑ NA ❑ NE
El Yes / No ❑ NA ❑ NE
❑ Yes F!(No ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

FF cility Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5-To' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No gT15X ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ts ❑ 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
[ ,Ne ❑ 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
1g,'"'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑.Ido
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q.No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2<0
❑ NA
❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): -5 ez-'K� 4-4F � o
v- - -
---
13. Soil Type(s): L44 c 60&A ML&
14. Do the receiving crops differ from th se designated in the CA MP?
[-]Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2-go
❑ NA
C] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EKO
❑ 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
ff*�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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ f No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili' Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours 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)
KFN-5' ❑ NA ❑ NE
r o ❑ NA ❑ NE
❑ Yes E>1T— ❑ NA ❑ NE
❑ Yes qp a— ❑ NA ❑ NE
❑ Yes o 0 NA 0 NE
❑ Yes ©-No ❑ NA ❑ NE
❑ Yes [2-196 ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector'fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑'�o
❑ NA
❑ NE
❑'No
❑ NA
❑ NE
2 o
❑ NA
❑ NE
2'l�lo
❑ NA
❑ NE
Comments (refer to question�ft-Explain-anyNES answers and/or any additional Use drawings of facilityto better explai ituaiio s(u eadditi additional p ages necessary)-endations or- ny� co�iinments.
-6oJvL6 r4c o,,., � - ;,) - 0 ul/6 _'3 (' j if
S I,,- '_ S'.Vu^y
C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I �'.�'6-ry
Phone: 7 }
Date: 6 ws_
V4,20v

ype of Visit: 'I) Corm,. lance Inspection O Operation Review O Structure Evaluation O Technical Assistance t
'.e�aso_0.f-Ir"Visit: [d Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Az
Time: Departure Time: County: Region"
Farm Name: �aJlli/(.� Owner Email:
Owner Name: 4,un Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
iJ
Certified Operator: 1
Back-up Operator:
Location of Farm:
IS
�Wjj
Latitude:
Phone:
_ Integrator. �
Certification Number: 1 0 q
Certification Number:
Longitude:
Cpo ent Design Current Design Current
Somme Caeagn
p ty p. ultry�.r � Capacity Pop. _Cattle Capacity Pop.
V1'etl'o
Wean to Finish Layer Dairy Cow
Wean to Feeder Non -La er
Dairy Calf
Feeder to Finish _ "` '"
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder D kP,oultp
Dry Cow
Non -Dairy
Farrow to Finish ILayers.
Gilts Non -Layers
Boars Pullets
Turkeys
Beef Stocker ?
Beef Feeder
Beef Brood Cow
Turke Poults
rCIMer
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 [allo ❑ NA ❑ NE t*
[:]Yes
❑ No
E NA
❑ NE
❑ Yes
❑ No
['j,KA
❑ NE
❑ Yes
❑ No
[ErNA
❑ NE
❑ Yes
[311lo
❑ NA
❑,NE
❑ Yes
�No
❑ NA
❑ NE'
Page 1 of 3
21412011 Continued

,I
Facility Number: jDate of Inspection::P
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑'Yes
[21_N.e,
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
F>�
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I!d" o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EVT;ro
❑ 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
E2-<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
210
❑ 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
[B No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W.*6
❑ 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 of Approved Area
12. Crop Type(s): -9ed- A,ll ;A f`YIF 0U�v,,'-SGG1D
13. Soil Type(s):
u
14. Do the receiving crops differ from those designated in thWAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
Required Records & Documents
D Yes L. j-1 . NA ❑ NE
[:]Yes Q<o ga"NA ❑ NE
[:]Yes Po ' TA ❑ NE
❑ Yes Ejj No dNA ❑ NE
❑ Yes ��No ❑ NA ❑ NE .
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E]'Ivo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C`' L"O
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
l-1 ""'
❑ 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
U�FNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [,-I"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faci Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pel, it.
❑ Yes
©'i'Gli ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
❑,Ko ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey C] 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
E] o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[04go ❑ NA
❑ NE
Other issues
28. Did the facility fail to property 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? ❑ Yes [E�<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [B No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2 No ❑ NA ❑ NE
Comments refer to question Ex iain.an y YES answers and/or any additional' recommendation or an other comments.
( � �� P.� � y Y _
Use drawings of facility to better. explain situations (use additional, pages as necessary). xr �
sWsr. ga"� lo- 7-13
C`V tf Ki11Y t/l
Reviewer/Inspector Name:
F] Yes Q_44o ❑ NA ❑ NE
❑ Yes [DA< ❑ NA ❑ NE
❑ Yes []INo ❑ NA ❑ NE
❑ Yes [✓<o ❑ NA ❑ NE
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Type of Visit: omppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: t p v Departure Time: ; County: f - Region. jF7X 0
Farm Name: l_u-F_a C /_ — / Owner Email:
Owner Name: �� fjTar sue_ �Q0 Phone:
Mailing Address:
Physical Address:
Facility Contact: %� sr j3d/L(/jGf� Title: _14-c .J —_ Phone:
Onsite Representative: �5 Integrator:
Certified Operator:
Back-up Operator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish La er
Design Current
Capacity Pop.
Design Current
CattEe Capacity Qop.
Dairy Cow
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
/
D . Poultry
- `
Design Current
Ca aci P,o
Dai Heifer
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
jBeef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other .Turkey Poults
Other I Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Dg No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CK No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

F26tity Number: 3 7 Date of lns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (3 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): l 4
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes CR No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes N 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 EQ No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes Jallo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /'�,.ymC r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑G No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
170 No
❑ NA
❑ NE
Records & Documents
_Required
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 FNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2&No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ELNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - R3 7 1 1 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U�L No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®.No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q 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?
❑ Yes RI No ❑ NA ❑ NE
❑ Yes DQ No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes No
[:]Yes ® No
❑ Yes E�L No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain -any. -YES answers and/or any additional recommendations or any other comments ; .,
Use drawings of faeility to better expiam `situations (use additional pages as necessary). r• w + "
Reviewer/Inspector Name
Phone: �/jD-o
_ A .
Reviewer/Inspector Signature: Date:,��A/3
Page 3 of 3 21412011

i ype or visa: w t-ompnance inspecuon u uperanon Keview v Structure Evamatton u r ecnmcar Assistance
Reason for Visit: 40) Routine Q Complaint O Follow-up 0 Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: 2 n1 Departure Time: < p County: mn onl Region: /br
Farm Dame: tr} Rsf— � �I /1Z� L LC Z- ! Owner Email:
Owner Name: C p1.1 1= EQ Rm S Phone:
Mailing Address:
Physical Address:
Facility Contact: L_ti RJ=,< 16AR r rcd _Title: Phone:
Onsite Representative: 61%P'y Integrator: P a
Certified Operator: i, 24=S BAR s,,sc le Certification plumber: 47
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design C•ur:rent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
y 1
Design Current
D , Moult , Ca a_c_iEy P,o
Layers
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Qther
Other
Pullets
s
Turkey Poults
ow
Beef Brood Cow
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c- What is the estimated volume that reached waters of the State (gallons)?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
gNA
❑ NE
❑ Yes
❑ No
[ 1NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No EZ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Ej No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes BZ'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FaciliNumber: - a ) "7 jDate of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
[yNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[jrNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[-]Yes
['No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3?No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
[�No
❑ NA
ONE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E�(No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[D/No
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
d No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g�'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): RCnV QP [ �f4 A2 Sc 5 . % . 0-
13. Soil Type(s): l3 c iZp C (� AL 10
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 EVr No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[DI�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[':kl�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
QTo
❑ 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 �To ❑ 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 (!]"'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0T<o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

• • r,
Facili Number: I Date of Inspection: 3 j
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CyNo
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a 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 B"No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes IyNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
dNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
[01No
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other-
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a(No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #) Explain any°:YES answers and/or any additional recom_mendahon''s or an3 other comments.
Use drawings of facility to better explain sitiiati ns (use additional pages as necessary).:: �_ - °< ...
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: kQ - ' L,%S
Date:���`
2/4120l l

4,� 113 /// q;&L
(Type of Visit: (,!I -Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: O-Koutline O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: y County: 51. . Region:
Farm Name: („[.0 L ! Owner Email:
Owner Name: V--.M Phone:
Mailing Address:
Physical Address:
Facility Contact: azt'wffs $GJ7..WC_L Title: Phone:
Onsite Representative: /y Integrator: &
Certified Operator: (:LEI'- s'S ' / Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Current Design Current
DesignAs-
*apactty Pan- Wet Poultry-T- 'Capacity Pap _
Layer
Design Cttrrent
Cattle Capacity Pop.
Dai Cow
Dai Calf
Dai Heifer
Wean to Feeder
-Layer
Feeder to Finish
M w.. Design
F� �� -
_ _ DPoal YCa act
Carrent�
Po
Farrow to Wean
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
€ . '
Qther,
Turkeys
Turkcy Poults
Other
I UMF—rOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2090 ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes []No ILd-<A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[]No
Q.X
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
[:]No
Q A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
0:3- o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
El—"o
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

iR
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [D "KA ❑ 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 2q-o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ['No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 2rl o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 21 -o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes [E'No
❑ NA
❑ NE
maintenance or improvement?
f
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [-]Yes ©-g-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 of Approved Area
12. Crop Type(s): -&rw,_L (&_ (6, C. V ,
13. Soil Type(s): L La",,.a 3&—_ C9 — V t 11p ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej4o
❑ NA
❑ NE
15. Does the.receiving crop and/or land application site need improvement?
❑ Yes
[3 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[., o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�F<o
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Required Records & Documents ��
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes I'J� "'o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E2-l'o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑✓rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No Q AA ❑ NE
Page 2 of 3 21412011 Continued

FacilityNumber: - Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q'Wo'_ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g.NtT ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
0 Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NSA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 2-A ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes to ❑ NA ❑ NE
❑ Yes s. o ❑ NA ❑ NE
❑ Yes Q-W ❑ NA ❑ NE
❑ Yes DoIvo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E 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? ❑ Yesjj_N'o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or,anyAtsther.comment"s. " I
Use drawings of facili, to better ex laih situafons use additional a es.. as necessa "� p`
ffel� '
40 f
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
�'X� -->r�5
Phone: g/U -1-%33 -31
Date:
2/4/201I

ylv,s - zz - ZO 10
Type of Visit &Compliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit l7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /'2/—o/O Arrival Time: g:3o Departure Time: County: Region: /C-00
Farm Name: nnC Owner Email:
Owner Name: (i 140 C_ F::'C-Y —S Phone:
Mailing Address:
Physical Address:
Facility Contact: [�u-S �� "ti-s' �- K Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = ° = 4 = Longitude: ° = "
Design Current
Design Current
Design C►urrent
Swine
Capacity Population
Wet Poultry Capacit} Population
❑ Layer
Cattle Capacity Population
❑ DairyCow
❑ Wean to Finish
❑ Wean to Feeder
❑ Non -Layer
El Dairy Calf
ED Feeder to Finish
0Da
Dry Poultry
El Dairy Heifer
❑ D Cow
❑ Farrow to Wean
Farrow to Feeder
Z
p
❑ Layers
ElNon-Dairy
Farrow to FinishEl
Non -La ersPullets
Beef Stocker
Gilts
❑Beef Feeder
EBoars
❑ Turkeys
❑ Beef Brood Co
Other
❑ Turkey Pouets
❑ Other
Number of 5trudures:
❑ Other
Discharges &Stream Impacts
,��,,��
1 _ Is any discharge observed from any part of the operation?
❑Yes
L� No
El NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
L7 ivA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
Q NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
�
LI' NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[❑
WJ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

I
I Facility Number: 192- 237 I Date of Inspection
Waste Collection & Treatment �,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L'J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes B<o ❑ NA ❑ NE
Structureo 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 ETNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 6_ Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental thre , 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? No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑yes 2
9. Does any part of the waste management system other than the waste structures require El Yes -ElNo ❑ NA El NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement? 11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EKo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
Q'No ❑ NA ❑ NE
No ❑ NA ❑ NE
No NA ❑ NE
o NA ❑ NE
o ❑NA ❑NE
Comments (refer to quesfi6n' I) Explain an YES:
( answers and/or any:recommendations or any other, comments ,`w
Use drawmgs`of facility to better explain situations..( use additional pages as necessary}. . <.
v
Reviewer/Inspector Name�Z Phone: QIO. �f33� 333�
Reviewer/Inspector Signature: Date: _7/— ZOO
12128104 Continued

r
$z—Z3 7
Facility Number: 8 —237 Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
Yes
ElL�'
,�,
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
0No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NN.
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
0�,,
13<0
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LE No
❑ NA .
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
Ej"
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3<o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Lhlo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D'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?
El Yes
���
[2 o
❑ 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
,_ /
EJ 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?
El Yes
L_'TNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B No
❑ NA
❑ NE
12128104

-B.iqs io - o e - Zoo 9
Facility Number I XZ Z37
i
VIVivision of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit ompliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint 0 Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /.� Departure Time: County: Sow Region:
Farm Name: C Owner Email:
Owner Name: r_10 G ►'% L Az YNL- .5� Phone:
Mailing Address:
Physical Address: `
Facility Contact: C� Tt�Y�✓s'L� Title: Phone No:
Onsite Representative: Integrator: r� ✓�
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number -
Back -up Certification Number:
Latitude: = Q = I =1 Longitude: = ° = 4
Design Current Design Current Design",`Current, ,
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity. Popalii
❑ Wean to Finish
❑ Wean to Feeder
D-Foe'eder to Finish ZOAD
❑ Farrow to Wean
arrow to Feeder Z
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Daily
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
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 {o ❑ NA ❑ NE
❑ Yes
❑ No
}T 5A
❑ NE
❑ Yes
❑ No
❑1 iqA
❑ NE
ff NA
❑ NE
❑ Yes
E-1 No
❑ Yes
No❑
NA
❑ NE
El Yes
ELT,
211ow❑ NA
❑ NE
12128104 Continued

Date of Inspection /O a
Facility Number: Z—Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 NNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
e"110 ❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): XKZ
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ffNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ErN. ❑ 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 []-Pdo ❑ 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 ElYes .�}�lvo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [IN6t ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9-t� 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 El Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) sle r N.. +c �.— t C ►'�'`c �. 5; ` C// 46; f? , � � ( (i s5 _�
13. Soil type(s) A•--, Jill(_ t f.J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QNo
❑ 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
L7 N
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is lack
[I Yes
7No
❑ NA
❑ NE
there a of properly operating waste application equipment?
❑ Yes❑
NA
❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: ylQ, y133. 333 )1
Reviewer/Inspector Signature: Date: % -/O
11125104 C'onlinued

Facility Number: gZ—Z3 Date of inspection - p--D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [TNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No� NA
❑ NE
24.
Did the facilityfail to calibrate waste application equipment as required by the permit?
PP q q P
❑ Yes
,R
LTiVo IJ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
E<❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Lj No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
- No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L7 No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
.,�
93 ❑ 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
ff No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0_90 ❑ NA
❑ NE
Comments and/or Drawings:
12128104

.'� $�izcS �- 0 Y-o 8
Type of Visit O'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �outine O Complaint 0 Follow up 0 Referral O Emergency 0 Other El Denied Access
Date of Visit: —�1� Arrival Time: Departure Time: County:
es C�
Farm Name: _ C_DLiol_yi� Ari- / Owner Email:
Owner Name: Phone: 8� Ff'�'�%
.Mailing Address:
Phvsical Address
Region: C�A9
Facility Contact: Lzkn�S �Gi I'u// C/C _ _ Title: �� � .5/p�� Phone No:
Onsite Representative: Integrator: Ca Zia.-!� e- 1-�•
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = = N Longitude: = ° = 1 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La cr
❑ Wean to Finish
El Wean to Fe
Feeder to Finish
Z000
W
Lj Farrow to Wean
Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
El Other
Dry Poultry
❑ La ers
ElNon-Layers
ElPullets
❑ Turke s
El Turkey Poults
El 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?
Cattle
Design Current"°
Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dai
El Beef Stocker
El Beef Feeder
El Beef Brood Cow
Dumber of Structures:
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?
f
❑ Yes © No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NE
❑ Yes ❑ No WNA ❑ NE
❑ Yes Q No /NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: L1rZ_—Z3A Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZN.�
❑ NA [I NE
a. If yes, is waste level into the structural freeboard? ❑ Yes❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r�
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ 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!tbpeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ 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 LI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � ❑ NA ❑ NE
maintenance/improvement? 7
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
\of Area
t2. Crop type(s) ,(j t.o-A4, F � 6(rc.
l3. Soil type(s) Au Gcia
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
V
❑NA
❑ NA
7N9❑ NA
�N�o[]
NA
NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
� �
Comments (refer to gnestton # Explain any YES --answers and�recommendations or any other comments.
(Use drawmgs'of facfliA,; o better e
F h . xplam situations (use aildifional;pages as necessary): r
Reviewer/Inspector Name �� �/�� S � Phone: 9Vi , 4(.33, 33-30
Reviewer/Inspector Signature: Date:
Page 2 of 3 12173104 Continued

Facility Number: Z —2.5 T Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 0/No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑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 V Rain Inspection�-NTNO
Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�N
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
30.
and report the mortality rates that were higher than normal?
At the time of the inspection did the facility an odor or air concern?
pose quality
❑ Yes
N
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/Drawtngs�
Page 3 of 3 11/28104
Page 3 of 3 11/28104

AX40 ev&ve_eL y--1B—Loo7 ZC_
Facility Number gZ 3 7
® Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit ® Compliance Inspection O Operation Review O structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 19-13-07 1 Arrival Time: Departure Time: County: S4'4/JSo.J Region: :eI
Farm Name: C _ 1 Owner Email:
Owner Name: Co
Mailing Address:
Physical Address:
Phone:
Facility Contact: a r47s Sq,4 k Title: Phone No:
Onsite Representative: Integrator: --
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 o 0 i Longitude: 0 0= = u
Design Current`` Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
7-ODD
��ZS
❑ Farrow to Wean
Farrow to Feeder
fp
�a ✓�
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Other
Poults
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?
y;<,
Design Curr
Cattle Capacity Poptila
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
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 R No ❑ NA ❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
[)I No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[5?No
❑ Yes
[�? No
❑ NA
❑ NE
❑ Yes
[)?No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes LRpArNo
❑ Yes E� No
Structure 5
❑NA El NE
❑NA ONE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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 MNo ❑ 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 [gNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 Q0 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 W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
}
12. Crop type(s) d �. t! �� ��'rg .:✓ C. fS Ifrw� 5 e t r,/ J _
13. Soil type(s) ALI r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V1 No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes
)M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
rO No
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application? ❑ Yes
4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
J0 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):
/ �� s �� �c! ++ll %ems i/L�/14ai i iJ %a+✓
�C 4foo�+/ S`c�� lx+w`ducd 4.S aD �� 1
AL
VW01-11 iJo�Cv �iarr.(.
Reviewer/Inspector Name G eve 15 Phone: 9/d • f�33-33aa
Reviewer/Inspector Signature: Date: %3 r Zdd
12128104 Continued

Facility Number: ?'Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UTNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [)No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V3 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
y No
❑ NA
El NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
ElNA
❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes4No
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
PNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
17No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R] 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
�A 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
LOB
❑ NA
❑ NE
General Permit'? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

A 0 Division of Water Quality
Facility Number L'�ZZ �_21�37 O Division of Soil and Water Conservation
O Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 41-25-D Arrival Time: 0; O % Departure Time: County: Region: l�
FarmName- CZ a .-- C_ Fa r b^,_< C -1- Owner Email:
Owner Name: C o 6.C,t, ; �� S !=a v �.•. Phone: �9ia� sl Z - //_2 2-
Mailing Address:
Physical Address:
Facility Contact: C ��'�+ 5 �[: Vfa I 'Title: L' £ }=N ✓ ilfwt��r=hone No:
Onsite Representative:
Integrator:
Certified Operator: ruk:�&1 4IiiNJc11C Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: El b FT ❑" Longitude: = ° = I ❑
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
OD12,01oS-1
El Farrow to Wean
Farrow to Feeder
, s0
Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischariLes & 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 Cow
Number of Structures: E'
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)
Z. 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 CK.No ❑ NA ❑ NE
❑ Yes
rg No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[A No
❑ Yes
Q No
❑ NA
❑ NE
El Yes
ZNo
❑NA
ONE
12128104 Continued

Facility Number: 9Z-23
Date of Inspection 41 -ZS-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
[Structure 1
Identifier:
Spillway?:
r . �
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes CA No ❑ NA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes (9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N 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 D9 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 5? No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drifl ❑ Application Outside of Area / 1
l2. Crop type(s) Sc jV01 u J� f G' S / v� �e'xr�+ /�Y= -
., -
13. Soil type(s) 4U.1kNV 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L,11No ❑ 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
[ANo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
PO No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
P No
❑ NA
❑ NE
Reviewer/Inspector Name ,; G K_ V Gl(� Phone:
Reviewer/Inspector Signature: zA—e,4l_� Date: Z Z5"-- zoo 4-
I2128104 Continued

Facility Number: Date of Inspection — G
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (9 No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IN No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I@ 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
2d No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
A 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
ZNo
❑ 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
Pd No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
k di6DEAIErn' nmd an lo:'I)ft$WWgS 4'` • , k � "' H i??
12128104

37
Type of Visit @ Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine 0 Complaint Q Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:—SQ^�nRegion: r'/.? 0
Farm Name: 4a lTa� i rz F .-A" if- � _ _.. Owner Email:
Owner Name: _ � do.- % c. -�orq. _ r41n-5 Phone:
Mailing Address: 306 4.2e. -Ae rx 4.e. -fowl /V C Qys2p
Physical Address:
Facility Contact:
Onsite Representative: . �'J
Certified Operator: . i -f
Back-up Operator:
Title:
Phone No:
Integrator: Ca �4► �C A" ,, 3 s
Operator Certification Number: 0 1 ��
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ ` E__1 " Longitude: 0 ° 0' E__1 `,
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
pav
/98
0 Narrow to Wean
Farrow to Feeder
6.244
609
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Design .Current-,
Cattle Capacity Population
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
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 [Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[4 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: k,2 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
n
Designed Freeboard (in): / �/, ,2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V] 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
W] No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
91 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 l0 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) /�Lr.�.rr�a_g rG zrce Lo
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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
® No
❑ NA ❑ NE
Reviewer/Ins ector Name '
`` 5
P Q;rr. a <c �� ;.=_� � Phone: 9/o /.S"Y
Reviewer/Inspector Signature: Date: -2 /r os
12128104 Continued

Facility Number: a -,2271 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rk] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J] No ❑ NA ❑ NE
the appropiiate box. ❑ WUp B Checklists ❑ 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 ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IN No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[K No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
8 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
1
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Cngame-nts;and/or Drawings _ t; '
12178104

Facility Number Date of visit: 3 6 Time: 3: ea
� � ��
Not erational Q Below Threshold
04'e—rmitted �ertified 13 Conditi nall Certified 13 Registered
Farm Name: 4�G r
Date Last Operated or Above Threshold: ..
County:
Owner Name d t r i C F S Phone No:
Mailing address: 3m t,• vo%m P" ?d
Facility Contact: _.�''. . !''�4.._. •----•-----•-----Title: ----—'------ r----._ Phone No:
----... _. __.. ........
Onsite Representative:. { n� rG k Integrator-. » ��' �+`
Certified Operator:._.»_ {�'i»5 _ _ __ » _ �_ Operator Certification Nnmber•
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ horse Latitude Longitude �• �� �«
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes BM)'
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ Na
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ca-??t5'_
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Structure 2 Structure 3
Structure 4 Structure 5
❑ Yes Lvo
Structure 6
Identifier:
Freeboard (inches):
12112103
0
Continued

)Facility Number: $ > — 7 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
9-?16'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
D Yes
Leo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
Yes
<0
7. Do any of the structures need maintenancelimprovement?
❑
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
O
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
D110
elevation markings?
Waste Application
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
pding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Excessive Po
12. Crop type . oaS1 �[ , �� A r -
13. Do the receiving crops differ with those -designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes QNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Q>Ko�
b) Does the facility need a wettable acre determination? ❑ Yes Y�, �" �0
c) This facility is pended for a wettable acre determination? ❑ Yes ,l-fi O
15. Does the receiving crop need improvement? ❑ Yes 1�'!vo
16. Is there a lack of adequate waste application equipment? ❑ Yes Q,picr__�
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 2<0
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 21/No
Air Quality representative immediately.
Reviewer/Inspector Name
Reviewer/Impector Signature:
Copy ❑ Final Notes
Date: �� G
12112103 / / Continued

Facility Number: — a Date of Inspection Dx o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes la- o
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [p1',
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25_ Did the facility fail to have a actively certified operator in charge?
❑ Yes
01Imo
26_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑W6'
28. Does facility require a follow-up visit by same agency?
❑ Yes
Leo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑�O
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
G Pi6'
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
G-No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

r
Site Requires Immediate Attention: /A10
Facility No. _PZ - 01
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:.JJ� U 1995
Time:
Farm Name/Owner: C 0 k af', e F c, ". '" `1`C r I
Mailing Address: C: o C
County: -_ �-
Integrator: _ C h 5"- e _ _ Phone: 5 ,/U _ 5_ 92 - // -42 _
On Site Representative: C _.�r`F� S _ , ✓��� ..� `c./c Phone:
Physical Address/Location: P
Type of Operation: Swine Poultry Cattle
Design Capacity: 2�s� _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification
fo
Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard:__c�Lfft. __�LInches
Was any seepage observed from the la n(s)? Yes or (& Was any erosion observed? Yes ori&
Is adequate land available for spray? es or No Is the cover crop adequate? I or No
Crop(s) being utilized: /3 ee
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e)or No
100 Feet from Wells? 0 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or &o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or iDoo If Yes, Please Explain. -
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

• � � Site Requires Immediate Attention: d
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2-0 , 1995
Time: Zbo L*�
Farm NamelOwner:_ t -- - --
Mailing Address:
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: _�cu.� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h,
(approximately l Foot + 7 inches) i
Was any seepage observed from the
Is'adequate land available for spray?
Crop(s) being utilized: _
Does the facility meet SCS minimum
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
�or No Actual Freeboard:-2— Ft. _Inches
oon(s)? Yes or &Was any erosion ob rved? Yes or N�o
CDses . No Is the cover crop adequate? V or No
setback criteria? 200 Feet from Dwellin ? ' or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or ci
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orQa
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o<�o If Yes, Please Explain.
Does the facility maintain adequate waste management r(volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? kiEoor No
Additinnal Cnmmenty
Inspector Name
Signature
,cc: Facility Assessment Unit Use Attachments if Needed.

i
REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by OEM. Please print clearly.
Farm Name:_ CAltri t F4e,^%1 -,.C� �-
Mailing Address: P.O. -64x rd v
;r +V, G ZIP 3-29 -
County:_ 5..� �sy�. Phone No_
Owner(s) Name: 2. rl"- Fa; I 1 I„ram, W, ffi�5�•+
Manager (s) Name: LlavJ Alev
Lessee Name: N 4 - --
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.) . ��� �. �. 4,-,W", pnC (s eP
Latitude/Longitude if known:
Design capacity of animal waste management system (Number and type
of confined animal (s)) 6.2y-s,1,- KAY, 4--- - -2odi7
Average animal population: on the farm (Number and type of animal (s)
.raised) (CJy A
Year Production Began: ASCS Tract No.: �5
Type of Waste Management System Used: _Z- 4 cc,
Acres Available for Land ApRligation
Owner (s) Signature (s) :
aste : S!
i7 DATE: �d-/5--- 93
: Id is--9 3

map
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Ce40t..c FarMs c
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