820282_INSPECTIONS_20171231

14
NUH I H UAHULINA
Department of Envimnmental Qual

il &onreF75—tioo
RESSED � �_—e �A 0
9
TypeofVisit: UCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (31foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
jj;' Arrival Time: Departure Time; County:
Date of Visit:
Farm Name:
T/-/rL- Owner Email:
Owner Name: Phone:
Mailing Address:
Region:
Physical Address:
Facility Cantact:
Title: Phone:
Onsite Representative: Integrator: llylr-42�
140,
Certified Operator: Certification Number;
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Fren
C aps
! C
Wean to Finish
yer
Dair
_y Cow
Wean to Feeder
�hN
n-Layer
Dairy Calf
Feeder to Finish
'4z
i
Dai!y Heifer
Farrow to Wean
Farrow to Feeder
furre t
P.
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stoc. er
Gilts
Boars
A e
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharm and Stream Impacts
I . Is any discharge observed from any part of the operation?
[:]Yes
B<o
[3 NA
F] NE
Discharge orionated at: 0 Structure Application Field F-1 Other:
a. Was the conveyance man-made?
E] Yes
Ej No
Ej NA
Ej NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Ej Yes
Ej No
[D NA
0 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)
E] Yes
0 No
Ej NA
0 NE
2. Is there evidence of a past discharge from any part of the operation?
Ej Yes
[ffN—o
C] NA
[�] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
E31qo
[:] NA
D NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

fFfac—ifity Number: Date of inspection:
Waste Collection & Treatment
:4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes D<o D NA ONE
a. If yes, is waste level into the structural freeboard? D Yes D No D NA D NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed FTceboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? 0; Yes [a5o D NA D 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 D Yes [3-No [-] NA E] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes [EtNo
[:] NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes [3-No
D NA
NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require 0 Yes [EJ�No
D NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes [ErNo
Ej NA
N E
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes �o
D NA
N E
Excessive Ponding Hydraulic Overload [:] Frozen Ground
OHeavy Metals (Cu, Zn, etc.)
F1 PAN F-1 PAN > 10% or 10 lbs. Total Phosphorus D Failure to Incorporate Manure/Sludge into
Bare Soil
[:] Outside ofAcceptable Crop Window 0 Evidence ofWind Drift
[:1 Application Outside ofApproved Area
12- Crop Type(s): Coe-�' eal— /' ��4,2"4 -
13. Soil Type(s): A , 14, t Z Lk Z X 4 �" ---s
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes EarN�o DNA D NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes [3"go DNA [:] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable E] Yes [31�o [:] NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
Yes E]r'N"o NA D NE
Yes E�J'No NA ONE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
[31�o
DNA E] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
�o
DNA ONE
the appropriate box.
D WUP ElChecklists [:]Design [:] Maps D Lease Agreements
[—]other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
D Yes
[]rNo
DNA D NE
0 Waste Application E] Weekly Freeboard D Waste Analysis [:] Soil Analysis
D Waste Transfers
D Weather Code
ORainfall [:]Stocking 0 Crop Yield [:] 120 Minute Inspections Ej Monthly and V Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
E3f90
[:] NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes Ea"No 0 NA D NE
Page 2 of 3 21412015 Continued

.lFacility Number: JV�L- Date of Inspection: _-jM;a3PL
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
[3'<o
[DNA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
0 Yes
[3-No
[:) NA D NE
the appropriate box(es) below.
F] Failure to complete annual sludge survey OFailure to develop a POA for sludge
levels
F] 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?
0 Yes
�o
DNA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 Yes
0-Mo
D NA NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
[:]Yes
C],M
NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
�o
NA 0 NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
E3 Yes
[T<o
NA NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
�o
D NA NE
El Application Field [:] Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
LT<o
NA NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
Yes
BNo
NA NE
34. Does the facility require a follow-up visit by the same agency?
Yes
Q-No
NA NE
C ommentsi (refer to question #):.Explain any YES answers adiVb "J'-fipsidditional recommendiition!'yo"�'C;!"n'y-o-thii;coihm6nt'�.,,"
r
IMMAR
Mgs cility to bettcr explain situations (use additio pages as necessary).
ReviewerA nspector Name: _.j��7
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

I
IType of Visit: J>C!4-nipliance Inspection 0 Operation Review 0 Structure Evaluation C) Technical Assistance
Reason for Visit: 040�`utine 0 Complaint 0 Follow-up 0 Referral 0 Emereenu 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Z,:k V a , ±- .:5 V,,-,
Owner Email:
Owner Name: 477 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: 122�� V
Certified Operator: Certification Number: /Z�
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude -
n7t IMMKo D ign I
MWI C'Daci lRo
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11
iNon-Layer I
Dairy Calf
Feeder to Finish
Daia Heifer
Farrow to Wean
ent Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
ee toe er
Gilts
ers
113eef
Feeder
Pullets
R - d Cow
Boars
Turkeys
Al
Turkey Poults
Other
Other
Dischar2es; and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure Application Field Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notif-yDWR)
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 [allo E] NA E] NE
Yes No
Yes No
[-]Yes [:]No
[]Yes [gNo
[—]Yes JR No
NA [—] NE
NA E] NE
NA NE
NA NE
NA NE
Page I of 3 21412015 Continued

Facility Ku—mber: 82-- jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes 0 No D NA D NE
a. If yes, is waste level into the structural freeboard? M Yes D No D NA D 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? OYes [3No DNA ONE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a DYcsgNo DNA ONE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation pos" an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? E] Yes Q No D NA [:] NE
8. Do any of the structures lack adequate markers as required by the permit? Yes [allo D NA NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes (&No NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes 2 No NA NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. E:] Yes E�_No E] NA [:] NE
F1 Excessive Ponding D Hydraulic Overload [:] Frozen Ground D Heavy Metals (Cu, Zn, etc.)
F] PAN F-1 PAN > 10% or 10 lbs. 0 Total Phosphorus E] Failure to Incorporate Manure/Sludge into Bare Soil
n Outside of Acceptable Crop Window Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): Col^rk_ _t
13. Soil Type(s): LA L:2i PS Z 2LE
14. Do the receiving crops differ from those designated in the CAWMP? Yes [2�No [—] NA [:3 NE
15. Does the receiving crop and/or land application site need improvement? Yes �o D NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ja No D NA NE
acres detennination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
[:]Yes allo [:] NA D NE
[:]Yes JK No DNA [:] NE
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
D Yes
12!1,No
NA NE
the appropriate box.
OWUP [:]Checklists E] Design 0 Maps D Lease Agreements
EjOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
[:] Yes
J!!kNo
NA NE
F-1 Waste Application [:] Weekly Freeboard [:] Waste Analysis [:1 Soil Analysis
D Waste Transfers
Weather Code
F-1 Rainfall D StockingE] Crop Yield E3120 Minute Inspections DMonthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
allo
DNA D NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes [�LNo D NA ONE
Page 2 of 3 21412015 Continued

Facility Number: - :2� jDate of Inspection; jg��_ �— �
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes PI -No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes allo
the appropriate box(es) below.
F-1 Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes [a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes CE[ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Application Field 0 Lagoon/Storage Pond 1:1 Other-
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerA nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
D NA D NE
DNA D NE
NA NE
NA NE
[:] Yes C3 No D NA D NE
[:] Yes EjNo D NA D NE
F] Yes [g No [:] NA D NE
[] Yes [gNo D NA D NE
Yes allo
Yes a No
[3 Yes E&No
Phone:
D NA D NE
[DNA D NE
[:] NA D NE
Date: -17
21412015

Ilype ot visit: (9 Compliance inspection U operation Review U Structure Evaluation UTechnical Assistance
Reason for Visit: CYRoutine 0 Complaint 0 Fotlow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I -f! D Departure Time: F777/_15___]County: Region: T /11v�
Farm Name: 4'& ilatt, ri -�F075 Fxt"er— Owner Email:
Owner Name -
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 41-Cult Phone:
Onsite Representative: Integrator: ff, r-s rt.
Certified Operator: J1,
Back-up Operator:
Certification Number: Z4 7qL
Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish I I Layer I
Dairy Cow
Dairy Calf
��2n to Feeder
I INon-LaXer
I
2Feeder
to Finish
I ID
7-
Dairy Heifer
Farrow to Wean up wi�ss
Farrow to Feeder
Farrow to Finish Layers
Gilts Non -Layers
Boars Pullets;
urkeys
-urkey Poults
er Dther
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El structure E] Application Field El 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 ftorn 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 D3,No [-] NA E] NE
Ej Yes [-]No
[:]Yes [:]No
[-]Yes [:]No
E] Yes [a No
0 Yes (a No
NA NE
NA NE
NA NE
NA NE
NA NE
Page I of 3 21412015 Continued

lFacitity Number: g�' - / 7_T jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
rA-No
D NA
NE
a. If yes, is waste level into the structural freeboard?
Yes
0 No
[:] NA
NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
D Yes
[&No
D NA
D 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
E] Yes
EgNo
[:] NA
D 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?
D Yes
ELNo
D NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
[Z No
E] NA
D 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
E] Yes
[0 No
D NA
D NE
maintenance or improvement?
Waste ADDlication
10. Are There any required buffers, setbacks, or compliance alternatives that need D Yes P No D NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, 0 Yes [allo [DNA NE
F-1 Excessive Ponding D Hydraulic Overload D Frozen Ground DHeavy Metals (Cu, Zn, etc.)
F-1 PAN M PAN> 10% or 10 lbs. Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
F-1 Outside of Acceptable Crop Window [:] Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s):
C - /_11
13. Soil Type(s): lkjdj7 VLAS / 9XX;_t1
14. Do the receiving crops differ from those designated in the CAWMP? Yes P�J_No NA NE
15. Does the receiving crop and/or land application site need improvement? E] Yes allo NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [!�,No NA N E
acres determination?
17. Does the facility lack adequate acreage for land application?
D Yes
EQ No
NA
NE
18. Is there a lack of properly operating waste application eq uipmcnt?
[:]Yes
E4,No
NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
DYes
0 No
D NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
K No
D NA
NE
the appropriate box.
OWUP DChecklists F]Design L]Maps D Lease Agreements nOther:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ELNo D NA F] NE
F1 Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers D Weather Code
FIRainfall E]StockingE] Crop Yield E3120 Minute Inspections 0 Monthly and I " Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes allo DNA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes Eg�.No [:] NA [:] NE
Page 2 of 3 21412014 Continued

10
I Facility Number: 5- jDate of Inspection:
4 24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes C3_No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [a No
the appropriate box(es) below.
E] Failure to complete annual sludge survey Failure to develop a POA for sludge levels
El 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 [3-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No
Otherlssucs
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El Application Field El Lagoon/Storage Pond M Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[D NA E] NE
(DNA [—] NE
[DNA [3 NE
E] NA Ej NE
[—]Yes [&No F] NA F] NE
F] Yes MNo F] NA [:] NE
E] Yes [&No E] NA F] NE
[:]Yes 0 No F] NA [D NE
[:]Yes [a No
[:]Yes [RNo
[:] Yes Eg-No
C3 NA NE
NA NE
NA NE
Phone: 270j+-3 3 ­3_-;t�—
Date: /"
21412014

rype of Visit: Z<&mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (3�1 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I ld.� 3� t—)—] County: Region:
Farm Name: Owner Email:
Owner Name: &.1 �62 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
� 1� i i"sian
Uri
Vurren
PAR
Desi
e
e5ifti
apa
S'-tapacity'm
—M OP
to Finish
RINI�on-Layer
Layer
Dairy Cow
to Feeder
Dairy Calf
ee er to Finish
Farrow to Wean
2!1
Layers
Dairy Heifer
DryCow
Farrow to Feeder
Farrow to Finish
Non -Dairy
cker
Gilts
Non -Layers
der
I
113oars
1
Pullets
Beef Brood Cow
Other.
15��Tr
Turkeys
Turkey Poults
LiQther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: E:] 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)?
E] Yes allo E] NA E] NE
E] Yes
[:]No
E3NA
E] NE
[3 Yes
[:]No
E3NA
F] NE
d. Does the discharge bypass the waste management system? (If yes, notify D") [3 Yes E] No NA E] NE
2. Is there evidence of a past discharge from any part of the operation? 0 Yes [5No NA [3 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes ELNo 0 NA E:] NE
of the State other than from a discharge?
Page I of 3
21412014 Condnued

Facility Number: 42 142�� FDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No NA E] NE
a. If yes, is waste level into the structural fteeboard? Ej Yes No NA [:] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Yes M No
DNA
C] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a Yes
[-] NA
0 NE
'�JNo
.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 10 No
D NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit? [-]Yes M No
W4
F] 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 E] Yes ZI No
D NA
E] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes IQ No
D NA
E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. F] Yes Eallo
D NA
[:] NE
Excessive Ponding [:] Hydraulic Overload E] Frozen Ground D Heavy Metals (Cu, Zn, etc.)
PAN 0 PAN > 10% or 10 lbs. E] Total Phosphorus D Failure to Incorporate Manure/Sludge into
Bare Soil
F] Outside of Acceptable Crop Window E] Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): 1<0en &1"'-)1
13. Soil Type(s): &"—:5
K Do the receiving crops differ from those designated in the CAWMP? E]Yes Callo DNA E] NE
15. Does the receiving crop and/or land application site need improvement? E] Yes [Z No D NA E] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable E] Yes 0 No D NA E] NE
acres determination?
17- Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
E] Yes RNo DNA E] NE
E3 Yes No D NA [:] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? E] Yes Jallo DNA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes rM No [:] NA NE
kl-k
the appropriate box.
[:]WUP [:]Checklists [:] Design 0 Maps [:] Lease Agreements ElOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. E] Yes RNo
El Waste Application El Weekly Freeboard El Waste Analysis 0 Soil Analysis E] Waste Transfers
E] Rainfall [] StockingD Crop Yield E3120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:] Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes No
NA [:] NE
Weather Code
E] Sludge Survey
D NA E] NE
[-] NA [-] NE
Page 2 of 3 21412071 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
E] Yes
O-No
NA E3NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
P_No
NA E] NE
the appropriate box(es) below.
F-1 Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
F-1 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?
E3Yes
[R No
D NA E] NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 Yes
[a No
D NA E] 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El Application Field El Lagoon/Storage Pond [] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Yes No NA [] NE
E] Yes JgNo D NA 0 NE
[] Yes [KNo D NA E] NE
OYes DdNo DNA [3NE
Yes CANo
Yes 1K No
Yes C3,No
[] NA [:] NE
[:INA [3 NE
E] NA [:] NE
Comments (refe'r. to -question #): Explain any YES answers.and/or any additional recommendations or any other:corn . m . enti
Wi4inwings offaioity'to befter explain situations (usi.addition-al'pages as necessary).
Reviewer/Inspector Name: Phone: CFO
C22?_= �C__
Reviewer/Inspector Signature: Date: L� �'( Z—AL
Page 3 of 3 21412011

Type of Visit: 10-Compliance Inspection 0 Operation Review (_-) Structure Evaluation Q Technical Assistance
Reason for Visit: 01R`o�utine 0 Complaint 0 Follow-up 0 Referral 0 Ementency 0 Other 0 Denied Access
<
Date of Visit: Arrival Time: Departure Time: County: _*, --,Region:
LE =15rp
.041-
Farm Name: v- Owner Email -
Owner Name: Phone -
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: integrator:
I
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
-a Sri V. OT
Design urrent
D ews ii i NWG
ty
EKGr ci 0 p
PT!
Wean to Finish ayer
Dairy Cow
Wean to Feeder
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
apaci p-
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_&N Turkeys
Furkey Poults
I I 10ther i
Dischar2es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure 0 Application Field D 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? (I f 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?
0 Yes 2,No DNA D NE
[:]Yes [-]No
0 Yes [—]No
Yes [:]No
Yes M' No
W-3.
[:]Yes. C4No
NA NE
NA NE
NA NE
NA NE
NA NE
Page I of 3 21412011 Condnued

Facility Number: 7- �� ED-ateof inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural fireeboard? E] Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in) -
Observed Freeboard (in): q
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
ELNo D NA [:] NE
[:]No DNA ONE
Structure 6
[:] Yes U&No [:] NA [:] NE
6. Are there structures on -site which are not properly addressed and/or managed through a 0 Yes [allo
[DNA
D 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 g]No
DNA
ONE
8. Do any of the structures lack adequate markers as ' required by the permit? Yes allo
[:] NA
0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require OYes RNo
D NA
[:] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes [R No
D NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [Q No
[:] NA
0 NE
Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
PAN F� PAN> 10% or 10 lbs. Total Phosphorus D 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): A1017"511<
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes FXNo NA NE
P_'
15. Does the receiving crop andfor land application site need improvement? Yes S No NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No D NA D NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Ej Yes �&No NA NE
0 Yes [0 No NA NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes 21 No NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes RNo NA NE
the appropriate box.
OWUP OChecklists DDesign E] Maps D Lease Agreements D Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes g No
El Waste Application D Weekly Freeboard E:] Waste Analysis D Soil Analysis [:] Waste Transfers
F-IRainfall [-]StOCking DCTOP Yield 0120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? E] Yes Jallo
23. If selected, did the facility fail to install and maintain rainbreakers. on irrigation equipment? 0 Yes 0 No
[:] NA [::] NE
D Weather Code
El Sludge Survey
NA NE
NA NE
Page 2 of 3 21412011 Continued

Facility Number:
4Z.2g;�� Kate of Inspection:
A92�
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes 0 No 0 NA [:] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes allo 0 NA 0 NE
the appropriate box(es) below.
n Failure to complete annual sludge survey Failure to develop a POA for sludge levels
E3Non-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? 0 Yes No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes RNo NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 Yes [K No NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond F-1 Other:
32. Were any additional problems notedvVhich 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?
0 Yes fallo [:] NA 0 NE
[:] Yes [Z No 0 NA 0 NE
[:] Yes Nd No [—] NA 0 NE
E] Yes [a No
Yes Q No
Yes Og-No
Cornments1refer: to.. question #): Explain any YES answers and/or. any additional recornmendati6hs or,any&
Use drawines of facilitv to better eXDlain situations (use additional oaLyes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
[:] NA [:] NE
0 NA E] NE
0 NA ONE
Phone: W 0 :::�_ _T_T 0 a
Date: 5--- 4,7==
21412011
Page 3 of 3

„' lDivi"sion of Water Quality
Facility Number �� - �$� O Division of Soi! and Water Conservation
O Other Agency
Type of Visit: Q5 Compliance Inspection . 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: DR= Arrival Time: j ; Departure Time:; County: Region: E& -
Farm Name: U rSAIya'l r 4 SQr1 rQ/M
Owner Name: U011
Mailing Address:
Owner Email:
Phone:
Physical Address: yQ(LC� � F i` Q l ivy
Facility Contact: J wTitle: 6-wrr Phone:
Onsite Representative: *LUf13
14IIntegrator:gp
Certified Operator: 1414 Sr/l ! U (�i Certification Number:
Back-up Operator: 2 Su t Certification Number: q8 rn7y�
a
Location of Farm:
Latitude:
Longitude:
Deli Current. Design Current Design Current
Swine=:-apacity#Pog��;°`•.WetPoultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
[Layer
Dai Cow
Wean to Feeder
I
INon-Layer I
alf
eeder to Finish
�{ p
Da' Heifer
I'
Farrow to Wean
' Design Current I Dry Cow
Farrow to Feeder
D , jgoult , Ca aci P,o P. Non -Da'
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
w::M-:.;i:-rfnv".c'A_^.:
uir.-'-'
Other
lsl'.Y.:,...n�l ...-I.::�_�T+Yu'Y4.
`irwEillY.frnsiur:: _:W'-.�•—.-".:IGW:xaeF.a.GJ ..,� ....
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
No
[] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IQ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
15� No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

lFacility Number: Date of Inspection:_,j I S- 1 IY7_771
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes No NA NE
a. If yes, is waste level into the structural freeboard? Yes No NA NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a7
5. Are there any immediate threats to the integrity of any of the structures observed? Yes n No E] NA C] 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 E] Yes L[ No C] NA [D 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?
[D Yes
&I No
NA
F] NE
8. Do any of the structures lack adequate markers as required by the permit?
E] Yes
[allo
NA
E] 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
E] Yes
[0 No
E] NA
E] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
�j No
[:] NA
[:] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
E3Yes
[E No
E] NA
[3 NE
F-1 Excessive Ponding F1 Hydraulic Overload 0 Frozen Ground E3Heavy Metals
(Cu, Zn, etc.)
El PAN M PAN > 10% or 10 lbs. Total Phosphorus E] Failure to Incorporate Manure/Sludge
into
Bare Soil
E] Outside of Acceptable Crop Window Evidence of Wind Drift 0 Application Outside of Approved Area
n .
12. Crop Type(s): fil gin V
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
C3 Yes
5j No
NA
NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
[5] No
NA
NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
E] Yes
CR No
NA
E] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
[R No
NA
NE
18. Is there a lack of properly operating waste application equipment?
E] Yes
allo
E] 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 ElChecklists [] Design [—] maps C3 Lease Agreements
Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
[2 No
Ej NA E] NE
Ej Waste Application 0 Weekly Freeboard Ej Waste Analysis [:] Soil Analysis
Waste Transfers
[:] Weather Code
MRainfall [3 Stocking[] Crop Yield 0 120 Minute Inspections E] Monthly and I " Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
23 No
[:] NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
E] No
RNA E] NE
Page 2 of 3 21412011 Continued

lFacHity Number: ED�ateof i�nsection- 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes CR No E] NA E] NE
25. Is the facility out ofcompliance with permit conditions related to sludge? Ifyes, check E] Yes CR No E] NA E] NE
the appropriate box(es) below.
E] Failure to complete annual sludge survey Failure to develop a POA for sludge I evels
E] 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 ceTtified operator in charge? Yes 0 No 0 NA [:] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [3 Yes E] No CRNA E] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document []Yes C5VNo [] NA [:] NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
E] Application Field [-] Lagoon/storage Pond r_1 Other:
[D Yes [a No E] NA [:] NE
E] Yes M1 No E] NA [:] NE
[D Yes [g No [:] NA E] NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—] Yes
[X No
NA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? E] Yes
CR No
NA
C] NE
34. Does the facility require a follow-up visit by the same agency? E] Yes
El No
E] NA
C] NE
Comments (refer to question #): Explain any YES answers, and/or any additional recommendations;o-!-�'a'ny-l'-o'ther..comments;
lUse d . rawings of faeffity to better explaii situations (uw;�' iional
p,
All emw��w
n pages as necessary.
WOMOIAo4-folm oidjodt reards,
Reviewer/Inspector Name: �-Qtj' 'Schm-p-pr Phone: qr
Reviewer/Inspector Signature: Date:Harb i r;
Page 3 of 3 21412011

19
FB
La don Nam! 4',-
9
f6fidHIW09i
2
3.
4
5
.6
Desighl. ree
a
Raa61a6d.
(in)
0bseNbd.:-.:'frw*b
J-
ct
SIudq6-S6rve'1v.-:D41W6
lain
Sludg6-Dethr(M
1 7..�N111",
.
Liquid Trt; Zone;
Ratio-SI U
OA5
Date'76UVdGdnolh
177��j
won- no a I
Soil TO(Da :,Crop Yield Transfer Sheets
pH Fidl6 Wettable Acres' ✓ RAIN GAUGE
:
Lime Needed WUP Dead box or incinerator
Lime' 'Applied Weekly Freeboard s Mortality. Records J
Cu-I 1 in Inspections,✓ Check Lists
41 Storm Water
25 120 min Insp. Needs, ��l
Weather Cnrlas
Verify PHON
Date last WU F F
Date Iasi WOp, a
App.°Ha*r'"aie
-7 0 PYL,
I .::; i! -
R nd affiliations
FRO or Fairm Records
Lagoon #
Top Dike
"i Stop Pump
Start Pump
j
4p; Zn-I 3000= 213 lb/ac .
Soil TO(Da :,Crop Yield Transfer Sheets
pH Fidl6 Wettable Acres' ✓ RAIN GAUGE
:
Lime Needed WUP Dead box or incinerator
Lime' 'Applied Weekly Freeboard s Mortality. Records J
Cu-I 1 in Inspections,✓ Check Lists
41 Storm Water
25 120 min Insp. Needs, ��l
Weather Cnrlas
Verify PHON
Date last WU F F
Date Iasi WOp, a
App.°Ha*r'"aie
-7 0 PYL,
I .::; i! -
R nd affiliations
FRO or Fairm Records
Lagoon #
Top Dike
"i Stop Pump
Start Pump
j
4p; Zn-I 3000= 213 lb/ac .

bod, � In I D
ADiTrigion 5 a
UM e 0 Di 'si6 S6ff[a—ndj8Zat-e5LU,. onset
6001
TypeofVisit: Iff Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: '& Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: FS-155 Arrival Time: Departure Time: County: SJ-M)PSO�7 Region: Fke)
- --- I V
Farm Name: 0 S I,- f�p_ Owner Email:
Owner Name: U/IV 5-411 VOA Phone:
Mailing Address:
Physical Address: 4 qp Co k.,q,- Ltae PJ_
Facility Contact: Title: Phone-
Onsite Representative: --J-A'f'S.'H1V6A Integrator: IUIP
Certified Operator: Robe+ 0)+ef Certification Number: q 19 (01 lid)
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
ou
r,- , r C iffignt
"!Mgn
F) 14 U
"25-MMM �Oslnlhs.� =FFM
'M
nt
e
M-D
V_ - C - 0
qapci
X-13''"I'141,111,111111
1- 1 11 1
q 1
P
0
1 rvo -
P
to Finish
r
Layer
Dairy Cow
Dairy Calf
to Feeder
r to Finish _;)L4RC)
Dairy Heifer
Farrow to Wean
nt
Dry Cow
Farrow to Feeder
Pike]
P.
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
1 113oars
Pullets
Turkeys
Beef Brood Cow
. . . . . . . . . . .. . ... . ... ...
Turkey Poults
er
�10thcr
Discharizes and Stream IMDaCtS
1. Is any discharge observed from any part of the operation? [:] Yes JR No [:] NA E] NE
Discharge originated at: El Structure Application Field Other:
a. Was the conveyance man-made? Ej Yes C3 No E] NA NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) E) Yes []No E] NA NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) []Yes 0 No E] NA NE
2. Is there evidence of a past discharge from any part of the operation? F] Yes [N No F] NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ffNo [:] NA NE
of the State other than from a discharge?
Page I of 3 21412011 Confinued

Facility Nu m her: Date of Inspectio�w. a.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes [RNo D NA D NE
a. If yes, is waste level into the structural freeboard? [D Yes D No DNA DNE
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 R No [:] NA [:] NE
(i.e., large trees, severe erosion, seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed through a Yes J�] No [:] NA [:] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmeuAal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes I No NA NE
8. Do any of the structures lack adequate markers as required by the pennit? Yes E>_�No NA NF
(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 E] Yes IR No D NA E] NE
maintenance Or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need E] Yes CR No NA E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. El Yes allo NA [3 NE
F� Excessive Ponding D Hydraulic Overload Ej Frozen Ground E]Heavy Metals (Cu, Zn, etc.)
PAN [] PAN > 10% or 10 lbs. Total Phosphor -us DFailure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window D Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14, Do the receiving crops ditTer from those designated in the CAWMP?
D Yes
Pg No
D NA
0 NE
15- Does the receiving crop and/or land application site need improvement?
[3 Yes
Eff No
D NA
D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
D? No
D NA
D NE
acres detennination?
17. Does the facility lack adequate acreage for land application?
Yes
tR No
NA
D NE
18. Is there a lack of properly operating waste application equipment?
Yes
5jrNo
NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
5�r`No
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
f53 No
D NA
D NE
the appropriate box.
EIWUP D Checklists E] Design 0 Maps E]Lease Agreements
[jOther:
21. Does record keeping need improvement? If yes, check the appropriate box below.
E] Yes
[g No
D NA
E3 NE
[3 Waste Application D Weekly Freeboard E] Waste Analysis D Soil Analysis
E] Waste Transfers
D Weather Code
M Rainfall M Stocking [:] Crop Yield D 120 Minute Inspections D Monthly and I " Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[D Yes
10 No
D NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
(D Yes
[:] No
PWNA
NE
Page 2 of 3
21412011 Condnued

lFacility Number- %?k - aTa jDate of Inspection: .3 /&\a
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
U No
D NA D NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
E] Yes
f�r No
D NA D NE
the appropriate box(es) below.
Fj 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?
PK Yes
D No
D NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Ej Yes
[3 No
D NA D NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
EjYes
RNo
DNA
DNE
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?
E:] Yes
W No
D NA
NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
t5rNo
NA
NE
permit? (i.e., discharge, freeboard problems, oveT-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
53 No
NA
NE
M Application Field 0 Lagoon/Storage Pond E] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
E] Yes
allo
NA
E] NE
33. Did the Reviewer/] nspector fail to discuss review/inspection with an on -site representative'?
EDYes
Cg No
D NA
NE
34. Does the facility require a follow-up visit by the same agency?
[:] Yes
j< No
0 NA
NE
Comments (refer to question ft Explain any-,VES answers and..16—rka "), ditionalrecommendations-or-.4 ___A_1ree­F_­ommen
1) _;ad
M.�
lUse-drawings of facility to better explain gituitions (use additibjtailjffi�cs as necessary).
.-t%
hp _ yvo- k lo, Yve yp+ 0) hm* -rde- UT- 14Y 00)
h ir
-Tht t4vict-L 01C -04 +0 Pal ' bff1,01)4Ne- T- le-c+ -00-fm -Cor aolSat'Aoo� iv
to-
C 6nd- I fri bAck U,� -
D4, M111 need- 0-aliblalb, thfi, y1p, j
yve-1 I r), a Ho �4 -(27^ aAd od recodf.
�)_6 PO/0
le - (� r S e- S VI'Ve ewcmeo
7 YY � y
Reviewer/inspector Name: -J-ooA Schrrpiq- Phone: 91U-qp—"0/VKPj
Reviewer/Inspector Signature: %It�lx Date: C-) )51
Page 3 of 3 21412011

4
Facility No. Fa rm. N a me - S4 S V" LIF,— Date 3
Permit COC
OIC NPDES(Rainbreaker PLAT Annual Cert)
FB
Drpps
ow
_W11JUTE
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
I —Design Flow
Actual Flow
Soil Test Date
pH Fields
Lime Needed Pat
Lime Applied
CU-1 Zn-1
Needs P
Wettable Acres
WUP
Weekly Freeboard _je,'
1 in Inspections
120 min Insp.
Weather Codes
urop Yiela . i ranste z5neets
Waste Analysis Date 11f la!fl
- 60 Day
+ 60 Day 1, L4 11--�
N Amt (lb/1 000 Gal)
RAIN GAUGE
Dead box or incinerator
Mortality Records
Verify PHONE NUMBEFS and affiliations It-va
DatelastWUPFRO 1150lq Date last WUP at farm �) W,(
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 lb/ac; Zn-1 3000= 213 lb/ac
App. Hardware

Type of Visit: eFCompliance Inspection 0 Operation Review 0 Structure Evaluation C) Technical Assistance
Reason for Visit: Q Routine 0 Complaint C) Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Tijine:[q� Departure Time: Eq�� County: Region: E9;Q_
Farm Name: 0 Sky ibe- Owner Email:
OwnerName: Phone:
Mailing Address:
Physical Address:
Facility Contact- syll . ownfr
f v0p Title: Phone:
Onsite Representative: J I b�� Integrator: R10i fm P
Certified Operator: _Pob�+ OafeL Certification Number: �/ I L?Xoa
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
urrent
Sw' e M. Capaeltm P.
D esi n mirr_,
0
aci ANO p.
P
attle Epacit
"Wean
lWean to Finish
airy Cow
to Feeder
t
airy Calf
5�fKeeder
to Finish
Farrow to Wean
Farrow to Feeder
al q8D
Z521
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Layers
Non -Layers
Boars
Pullets
Beef Brood Cow
�Qffbcer 11
r
cr
E��
...... ....
Turkeys
Turkey Poults
t t�e'r
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure El 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 CR No [:] NA [:] NE
Yes E:] No EDNA E] NE
Yes [3 No [:3 NA E] NE
[:]Yes
[:]No
Ej NA
E] NE
[:] Yes
W No
NA
NE
[:]Yes
N—No
NA
NE
Page I of 3 21412011 Continued

'K
LFacility Number: 4; - AL jDate of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes In No E] NA 0 NF
a. If yes, is waste level into the structural freeboard? [:] Yes [:] No [] NA [:] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3c�
5. Are there any immediate threats to the integrity of any of the structures observed?
E] Yes ErNo
E] NA
E] NTE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
E] Yes n No
[:] NA
[:] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
aYes E] No
NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes Er 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
E] Yes tR No
E] NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes IR No
NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
Yes PC' VN0
'o—
NA
NE
Excessive Ponding Hydraulic Overload [3 Frozen Ground Heavy Metals (Cu, Zn, etc.)
F] PAN E] PAN > 10% or 10 tbs. Total Phosphorus [:] Failure to Incorporate Manure/Sludge into
Bare Soil
[] Outside of Acceptable Crop Window E] Evidence of Wind Drift [:] Application Outside of Approved Area
12. Crop Type(s): (_Vfjj. -)OV&Af
13. Soil Type(s): NpA 15
14. Do the receiving Crops differ from those designated in the CAWMP?
E] Yes
Callo
E] NA
[j NE
15. Does the receiving Crop and/or land application site need improvement?
E] Yes
CR No
E] NA
NE
16. Did the facility fail to secure and/or operate Per the irrigation design or wettable
Yes
R No
[:] NA
NE
acres determination?
17, Does the facility lack adequate acreage for land application?
E] Yes
[5No
E] NA
E] NE
18. Is there a lack of property operating waste application equipment?
Yes
CR No
NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
[RNo
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
R No
E] NA
NE
the appropriate box.
OWUP OChecklists E] Design E] Maps 0 Lease Agreements
Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
[9 No
E] NA
E] NE
0 Waste Application Weekly Freeboard E] Waste Analysis E] Soil Analysis
E] Waste Transfers
E] Weather Code
M Rainfall [:] Stocking Crop Yield E] 120 Minute Inspections Monthly and I " Rainfall Inspections
E] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Ej Yes
[N No
E] NA
NE
23. If selcc�ted, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
[:] No
W-NA
NE
Page 2 of 3
21412011 Condmued

lFacility Number: 4RJL Date of inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes [R No ED NA E]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check F] Yes 15jrNo E] NA E] NE
the appropriate box(es) below.
Failure to complete annual sludge survey E]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? E] Yes No E] NA Cj NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes No CR NA F] 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
E:] Application Field [:] Lagoon/Storage Pond M 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?
E] Yes n No C] NA E] NE
E] Yes R No 0 NA [:) NE
E] Yes P No [—] NA [] NE
E] Yes 12 No E] NA E] NE
Yes
No
Yes
No
[:]Yes
UNo
[—] NA NE
[DNA NE
[—] NA ONE
Comments (refer to question #): Explain any YES-iinswers and/or. any additional recommendations or any, ot e
.3gqmm
We drawings of facility to better explain situations'.7 se.:additionid-pages as necessa
..A
-7, L 0-9 CW 1 r' I UVC-7--fir I 1-'1 1 17, If--Vr- I V I I V ;/ r (_ I V Iz- LA L_- f y
ej aaofAer (ftj not
�tde_ 6 1 of
Well M41hf1qhftt �_'O(M old-jed- tlec&o(
j
Reviewer/Inspector Name: Zion '!�2 h), 10 1-6-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qtLq3j-333Q p
Date; tTVAP fq oU
'Pc
21412011

0119
Facility No. qa-A.), Farm Name Date
Permit CDC 01C )ES (Rainbreaker
rmmv� Well
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard (in)
BOat-
Sludge Survey Date
I-511M
Sludge Depth (ft)
q.0
Liquid Trt. Zone (ft)
47
i
i
i
i
T�
Ratio Sludge to Treatment Volume
I
I
I
I
Calibration Date —EFOG
Flow
-Design .. . ....
Soil Test Date
pH Fields
Lime Needed
Lime Applied
CU-1 Zn-I
Needs P
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
�a, Yield Transfer
.Waste Analysis Date
NAmt(lb/100OGal)
RAIN GAUGE
Dead box or incinerator
Mortality Records
111111111flin
�=EWTT
- �-��fflmmr.
FIT - �,�
0 ff N, Pr W-1 M, 0
M ,
MR
=0
=2 MIME
=�
Verify PHONE NUMBERS and affiliations
Date last WU P F R 0 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Iblac
App. Hardware

Olwts -ov-f 1-6-1101(p
I
Type of Visit 79rcompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (�rRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: Arrival Time: DepartureTime: jj),5'0R County: 1... 0 Region:
Farm Name: 'S q-0 slvhe Owner Email:
Owner Name: 16k� --Phone:
t
Mailing Address:
Physical Address:
Facility Contact: I-Aq SLIII&V4 Title: Avn Phone No: 5qq_(yD0
Onsite Representative: /7" Integrator: f1eJ4,04-
j
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Form: Latitude; =0 =' [=]" Longitude: = 0 =' = "
gesig
WstMg-n� =Ourrenl n callgr-ent
,o Irl'o
apac!fyjLH P )!I�� �'R,�)SC�Popula�fion Capac ity P top u I fflil
,H12ti5:n=1W t ul�cb MZopulation
El Wean to Finish
JE1 Layer
I
I
El Dairy Cow
Wean to Feeder
I[] Non-Laer
IHL�
I
I
El Dairy Calf I
Feeder to Finish
1-0421 O.AQ
'10
El Dairy Heifer
Farrow to Wean
Lavers
Non -La ers
Pullets
E]Dry Cow
0 Non -Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cowl
Farrow to Feeder
El Farrow to Finish
Gilts
Boars
Turkeys
Turkey Poults
Other Other
ilJ-e-rT5-f[Sfr—uWct5Mres.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[_1 Yes
YNo
[] NA
EINE
Discharge originated at: El Structure El Application Field D Other
a. Was the conveyance man-made?
0 Yes
[I No
F-1 NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
E]Yes
[-]No
El NA
[:1 NE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Elyes
No
El NA
D NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
No
[:1 NA
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
CRNo
El NA
N E
other than from a discharge?
12128104
Confinued

Fai4lity Number:
Date of Inspection 11111til U2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
[I Yes tgNo
[3 Yes El No
Structure 5
[I NA EINE
0 NA F-1 NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
X-No
0 NA
[] NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed Yes ISNo
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public healtvor ekironmental threat,
El NA El NE
notify DWQ
7- Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
NYes
[I Yes
'qffNo
ERNo
[INA
Ej NA
EINE
El 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 D Yes N No El NA El NE
maintenance or improvement?
Waste Application
tO, Are there any required buffefs, setbacks. or compliance alternatives that need
El Yes KNo El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 19yes El No El NA [I NE
0 Excessive Ponding El Hydraulic Overload 0 Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[]PAN EIPAN>10%orl0lbs El Total Phosphorus OFailure to Incorporate Manure/Sludge into Bare Soil
1�&Outside of Acceptable Crop Window E]Evidence of Wind Drift El Application Outside of Area
.1
12. Crop type(s) L % ool - �vh tvt 3 o -Y, bea i
13.Soiltype(s) Q6)�'Ssl ky'A' / hjcy�ollf
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
Wo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
F-1 Yes
No
[I NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
allo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
allo
[] NA
[__1 NE
janV _eKQmme1fd
Msomnlents reMeNt2j"2 sti9nL#)2.hxp ESTanswergandtor -kr ationSfortanWoUtericonlruents;
W, S rajj�fli=tvto B-ett—erre—xvigifirsitun-tions ona IMP_eslasinecessax;�,,
A�
Reviewer/Inspector Name Phone: (qln) 4Jr3--330X'3a?3
Reviewer[Inspector Signature: Date: Nov m.:)010
Page 2 of 3 U 1 12128104' Continued

RE V IS C—D
Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes ERNo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes nNo [INA ONE
the appropriate box. El WUP El Checklists D Design [I Maps El Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. El Yes [5�No El NA [3 NE
0 Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El Rainfall El Stocking 0 Crop Yield El 120 Minute Inspections El Monthly and I " Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
[3 Yes Z No
—9
13 Yes 5j No
El Yes RNo
El Yes E�No
D Yes C3 No
El NA El NE
CR-NA El NE
[I NA [:1 NE
El NA [:1 NE
0 NA El NE
[I Yes [I No MNA [I NE
[:1 Yes SNo [I NA [I NE
[:1 Yes IgNo [I NA El NE
[:1 Yes M No E] NA El NE
El Yes [ffNo 0 NA 0 NE
El Yes
Ej No
El NA
El NE
El Yes
El No
El NA
El NE
7 � lee, e, VV V � al W-e_ a) la
'yoo, Nek-flof -e-
01 /1 IV P-r r & Fe & 1/,�Y/ , Crof tj� iV, Arb Y-,//Y
h Ave s o', d m �e d o'Cyw (S� kv r-1 '4
do? -e � -eAd vi �ealj
avp— S Suf v 7
Exce a q- r e t 64j.
J_ no+ d a bO.S jo cd
7e-9
0' Check 0�(_ bokej o,)
e- 305 A
12128104

-WC
Fa�ilityNol�,)-�S--)- Farm Name-,�h() -S�J�-e Date
Permit , �/ COC - 01C �� NPIDES (Rainbreaker PLAT Annual Cert)
M-MM
6WIT1,301! "Tmm ME 0:
MTV= IER, ffffi%
". *T�lm M n. N - ".
6WIT1,301! "Tmm ME 0:
MTV= IER, ffffi%
". *T�lm M n. N - ".
Des��oard
Observed freeboard (in)
Sludge Survey late
u e e th (ft)
Liquid Trt, Zone (ft)_
MOW, A
Ratio Sludg to -r-e- atment volume
Iffinffix"AMMMI FAM
Calibration Date
Design Wid
Actual Width
Soi I Te st Date tLkhl -p-, - S 0� 1C;V'J Wettable Acres RAIN GAUGE
pH Fields
jm�hplokk-
WUP Dead box or incinerator
Lime Needed IL�14*
CA/1
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections
Cu-I Zn-I
120 min Insp.
Needs P
Weather 6odes
Crop Yield
Transfer Sheets
Waste Analysis Date
- 60 Day
+60Day
N Arnt (lb/1000 Gal)
WWI
Verify PHONE NUMBERS and affiliations
Date ]a st WU P F RO J-.30 -0 3 Date last WUP at farrn
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 lblac, Zn-1 3000= 213 lb/ac
App. Hardware

bc- 9,�c
-f-c- --�Oq

-61-m S to — a S-- 0 0,0q
Type of Visit E)rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0-Ko"U'Une 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Arrival Tirne:
Date of Visit: 19-17 09 Departure Time, County: S�2=e-ro."
Farm Name: S 0 S-W;,J 4F__ Owner Email:
__t�_
Owner Name: !3 Phone:
Mailing Address:
Physical Address:
Facility Contact: ar-4i's Edwwot-k- —Tifle: sj-p�'_ C_ Phone No:
Onsite Representative:
Integrator:
Certified Operator: Operator Certification Number;
Back-up Operator:
Back-up Certification Number:
Region: ~
Location of Farm: Latitude: = 0 [--]1 =" Longitude: = 0 = "
Mesi'i _
�G u-
_ ;Un
.,et . ult-HIN-tiUr-j
,o:p--
es' urren
Wb.FV____aciMR07RuI5_tion
10
Wean to Finish
10 Layer
I
0 Dairy Cow
0 Dairy Calf
I
El Wean to Feeder
10 Non -Layer
[jrFeeder to Finish
PYWO—tZs/V
1
It-
ElLayers
El Non -Layers
El Pullets
Ei rurkeys
El Turkey Poults.
mOher
0 Dairy Heifer
0 Dry Cow
El Non-Daja
El Beef Stocker
0 Beef Feeder
El Beef Brood Co
r ------
.:Fq—ffir 15-e-WRISMU06=1
0 Farrow to Wean
El Farrow to Feeder
10 Farrow to Finish
I[] Gilts
JE1 Boars
er
Dischar2es & Stream Impacts
1. Is any discharge observed from any part of the operation?
[I Yes
Bl�o
[I NA
ONE
Discharge originated at: 0 Structure 0 Application Field El Other
a. Was the conveyance man-made?
C3 Yes
D No
.�A
EINE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[3 Yes
[3 No
3<A
[I 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
[I No
[3<A
El NIE
2. Is there evidence of a past discharge from any part of the operation?
E]Yes
B<o
Ej NA
[3 NE
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
E]Yes
D-Ko-
El NA
El NE
other than from a discharge?
12128104
Continued

Facility Number: 8 Date of Inspection
Waste Collection & Treatment
4- Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes MoNo 0 NA D NE
a. If yes, is waste level into the structural freeboard? [I Yes E<o D NA 0 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? 0 Yes 3<o C1 NA El NE
(iei large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed 0 Yes 3<o El NA F] NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7- Do any of the structures need maintenance or improvement? 0 Yes B<o [:1 NA [] NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[__1 Yes
W-116
El NA El 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
3<o
[:1 NA ED NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
ffNo
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[I Yes
B<o
[I NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground [j Heavy Metals (Cu, Zn, etc.)
[]PAN EIPAN>10%orl0lbs El Total Phosphorus [:]Failure to Incorporate Manure/Sludge
into Bare Soil
E]Outside of Acceptable Crop Window E]Evidence of Wind Drift El Application Outside of
Area
12. Crop type(s) Cby-li
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
ff 'No'o
NA El NE
15, Does the receiving crop and/or land application site need improvement?
E] Yes
B<o
NA [__1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:1 Yes
3"'N'o
[:1 NA El NE
17, Does the facility lack adequate acreage for land application?
[I Yes
Bogo
[:1 NA El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
2<o
[:1 NA El NE
ommenda an ot
comm"'erits."(iffoetb iind/or= AM n
W-11,kft
.1bsedrawjngsotfh6lit'yto.. etterexpla*m,sit't'i':itions.-(6iiaddiiibiair- MMIR...Z.' A
gesas necess.ary!)
..K
--F j - : - . . .
Phone: 910,
44
Reviewer/inspector Name
Reviewer/inspector Signature: _29.1A Re-#J� Date: 9—/7— 2-60cl
12128104 Continued

Facility Number: 82 —2:RZI Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes dNo El NA 0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 2"N"o El NA [:1 NE
the appropriate box. 0 WUP El Checklists El Design El Maps [3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes 21'N"o [:1 NA El NE
El Waste Application EJ Weekly Freeboard El Waste Analysis 0 Soil Analysis C1 Waste Transfers 0 Annual Certification
El Rainfall El Stocking [I Crop Yield 0 120 Minute Inspections El Monthly and I " Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes B<o [I NA [:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes [3<o [I NA [:1 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
OtherIssues
[:1 Yes
B<o
El NA
Ej NE
El Yes
0<7
El NA
El NE
[:1 Yes
ETN'o
[I NA
El NE
[:1 Yes
la<o
11 NA
El NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
D Yes
B<o
0 NA
[I NE
[I Yes
2<o
[I NA
El NE
0 Yes
[a<o
El NA
El NE
I--] Yes
[3'�o
[I NA
El NE
El Yes
ffoNo
El NA
[:1 NE
0 Yes
[E<o
[__1 NA
[:1 NE
12178104

8--Zq-0'3 rr-
SIM!&
Type of Visit eyc"ornpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(31routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other [I Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: %let A/ Phone:
MaRing Address:
Physical Address:
Facility Contact: Title: __/C-Cyla Phone No:
Onsite Representative: 3&�4 Integrator: CA IN41 14 9-- Fa ro"
Certified Operator: Operator Certification Number:
Back-up Operator:
, Back-up Certiflication Number:
Location of Farm: Latitude: =0 =6 =" Longitude: =0=6 =id
§JLGT—Ci
�Po P -ion
P2� '217t
UG' n ntm
Ga Ile I apaci ]on
111111 Flapnty
to Finish
er
Dairy Cow
to Feeder
-Layer
Dairy Calf
r to Finish 50
&0
i 'P�"M I ; I
D U t
- I
0 Dairy Heifer
Farrow to Wean
El Dry Cow
El Farrow to Feeder.
0 Non-Dat
Layers
El Farrow to Finish
Gilts
Boars
0 Beef Stocker
Non -Layers
10 Beef Feeder
0 Pullets
10 Beef Brood Cow
NUM e ures:
Turkeys
El Turkey Poults
Dischar2es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Ej Yes
[?rN.
El NA
[I NE
Discharge originated at: El Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
El Yes
El No
005"A
0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Yes
0 No
2<A
El 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
El No
ETNA
[I NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
2<o
[:1 NA
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
0`_N'o
E] NA
NE
other than from a discharge?
Page I of 3
12128104
Continued
0

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes EJ'No C1 NA ONE
a. If yes, is waste level into the structural freeboard? 0 Yes E3<o [I NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)- 3&
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes
ETNo [:1 NA [3 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
[3<o [:1 NA El 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? Cl Yes
31 or D NA [__1 NE
8. Do any of the stuctures lack adequate markers as required by the permit? 0 Yes
[;Ko El NA [I 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 [I Yes
ETS'�o' [:INA [:3 NE
maintenance or improvement?
Waste Application
10, Are there any required buffiers, setbacks, or compliance alternatives that need El Yes
8'5o [I NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes
9v'o- El NA [] NE
[I Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[]PAN CIPAN>10%or]Olbs D Total Phosphorus El Failure to incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window E]Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Coj-&f L" loeav
13. Soil type(s) RQ -, /�v Ald
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
[]'No El NA
El N-E
15. Does the receiving crop and/or land application site need improvement?
D Yes
ErNo El NA
[__1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
D<o El NA
El NE
17, Does the facility lack adequate acreage for land application?
0 Yes
ONo [I NA
[I NE
18. Is there a lack orproperly operating waste application equipment?
[I Yes
DIro [I NA
El NE
Reviewer/inspector Name I. R;C-K.4 ke_vcjs Phone: '7/0. V33, 3334)
Reviewer/Inspector Signature: _Pli_�X P'"__4_ Date: 9 —1_3­200 8
Page 2 of 3 12128104 Continued

Facility Number: IF2_ — Date of Inspection
Required Records & Documents
19- Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ONo EINA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes ZN. E] NA [I NE
the appropirate box. El WUP [I Checklists D Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
0Yes
B'N'o
[INA
ONE
D Waste Application []Weekly Freeboard E]WasteAnalysis []SoitAnalysis
OWasteTransfers
El Annual
Certification
DRainfall E]Stocking DCropYield 0 120 Minute Inspections E]Monthly and 1" Rain Inspections E]WeatherCode
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
El'N'o
[__1 NA
[:1 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes
B<o
0 NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[I Yes
[31�o
[I NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
D<o
NA
0 NE
26.
Did the facility fail to have an actively certified operator in charge?
0 Yes
[3<o
NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
1:1 Yes
B<o
[:1 NA
El NE
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWM.P?
El Yes
B<o NA
[:] NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
0< [:1 NA
El 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
D<o El NA
E] 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
[:1 Yes
EK'o�EINA
El 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
ETN'_o� El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
0'N-o [I NA
[I NE
,kddit16fi4-,,C-omwents. aud/or­Dka_��
Page 3 of 3 12128104

.6 1
V Division of Water Quali
IFacility Number 0 Division of Soil and Water Conservation
1 0 Other Aven—
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit- Arrival Time: Departure Time: County: Sf^fp,,�2^1 Region: -*�AW
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: CQV-4�S 13ck&,W1'C-K Title: 15�v. IkA�ir. Phone No:
Onsite Representative: CtArl-'s E-AaL.,jic-r, Integrator: Co�%CLVI 1L. pa_V_V�&s
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� a = [� 11 Longitude: [=o[=1 =U
Swine
Design Current Design Current
Capacity Population Wet Poultry
Capacity Population
Layer I I I
Non -Layer
10 Wean to Finish
El Wean to Feeder
rg Feeder to Finish
4f gO
MOX-_
El Farrow to Wean
El Farrow to FeedeL
El Farrow to Finish
El ciits
El Boars
Other
10 Other I
Dry Poultry
0 Layers
El Non -Layers
El Pullets
0 Turkeys
E01 urkey Poults
10 other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Cattle Cap . acity Poj
El Daia Cow
El Dairy Calf
I
El Dairy Heifei
El Dry Cow
El Non -Dairy
El Beef Stockei
El Beef Feeder
El Beef Brood Co�
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?
�R
[:1 Yes M No D NA El NE
Elyes
[3No
EINA
EINE
El Yes
EM No
11 NA
El NE
0 NA
0 NE
El Yes
[21 No
[jYes
[ANo
EINA
EINE
[:]Yv,s
[RNo
EINA
[JNE
12128104 Continued

Facility Number: Date of Inspection Flo__5_T- _5 -71
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E]Yes EA No El NA [__1 NE
a. If yes, is waste level into the structural fteeboard? [I Yes [A No [I NA [] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2r
5. Are there any immediate thTeats to the integrity of any of the structures observed? D Yes ID N o El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed 0 Yes [M No [] NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate pubtic health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes R No Ej NA El NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? El Yes
C9 No
NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes
[A No
C1 NA El NE
maintenance or improvement?
Waste Appolication
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
[X No
[__1 NA [:1 NE
maintenance/impTovement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. [:1 Yes
[11 No
0 NA ONE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
EIPAN 0 PAN > 10% or 10 lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window El Evidence of Wind Dfifi D Application Outside of Area
12, Crop type(s) Co uj L e-.- 4- '!�o 6 "e'l /V-!;
13. Soil type(s) &-oA No A Re- Oix 13
14. Do the receiving crops differ from those designated in the CAWMP? El Yes
[54 No
El NA ONE
15. Does the receiving crop and/or land application site need improvement? El Yes
[NNo
El NA Cl NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
M No
[:3 NA El NE
17. Does the facility lack adequate acreage for land application? El Yes
[;3 No
[:1 NA 0 NE
18. Is there a lack of properly operating waste application equipment? El Yes
[A No
El NA D NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name kkAC!3 Re—vtAs Phone: 9/0- '1-33,3300
Reviewer/Inspector Signature: ?, � R, Date: AD --0 9— 200 7 1
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes fA No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes [g No El NA EINE
the appropirate box. 0 WUP 0 Checklists El Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes EN No F-1 NA El NE
El Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El Rainfall El Stocking El Crop Yield El 120 Minute Inspections El Monthly and V Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
E]Yes
[3 No
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
[9 No
[:1 NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
E]Yes
[M No
El NA
[I NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[19 No
[:1 NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
E]Yes
[10 No
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[)I No
[:1 NA
NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
q No
E] NA
NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
E] Yes
EM No
E] NA
El NE
and report the mortality rates that were bigher than normal?
30- At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
99 No
E] NA
El NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
Yes
[�? No
[:1 NA
[] NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
E]Yes
[;D No
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
[A No
El NA
El NE
Additional Comments and/or Drawings:
A,
12128104

10 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
11,11 0 Other Agency 11
Type of Visit 0 Compliance Inspection 0 Operation Review 60 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 4"ther [I Denied Access
Region)F_�
Date of Visit: Arrival Time- Departure Time: County:—,
Farm Name: 0 su�, &::� t Vat, 1­1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S L-�, k
Certified Operator: Q)—
Back-up Operator:
Location of Farm:
S,Klne
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Boars
Other
10 Other
Latitude: =
Phone No:
integrator: -T.-D ff ) Pf,�,,
Operator Certification Number:
Back-up Certification Number:
, =" Longitude:= OFT = "
Design Current Design Current
Capacity Population WetPoultry Capacity Population
El Layer I
IEJ on-Layei I I
Dry Poultry
Layers
E]Non-Layers
El Pullets
E] Turkeys
10 Turkey Poutts
FE1 )ther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure C1 Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Pot
El Dairy Cow
El Dairy Calf
El Dairy Heifei
Dry Cow
Non -Dairy
El Beef Stockei
El Beef Feeder
El Beef Brood Cow,
Number of Structures: El . -` I
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'?
El Yes P No [] NA (3 NE
El Yes
El No
�INA
El NE
El Yes
El No
Ja NA
0 NE
[I No NA
El NE
El Yes
El Yes
No
El NA
El NE
[] Yes
No
n NA
0 NE
12128104, Condnued

4
CP Division of Water Quality
LAV
'Facility NAmber 0 Division of Soil and Water Conservation
tber AcFenev
rType of Visit 0 Compliance Inspection 0 Operation Review & Structure Evaluation 0 Technical Assistance
yp sol I
Reason for Visit 0 Routine 0 Complaint 0 Follow up C) Referral 0 Emergency ("ther El Denied Access
-2)1( ----1 Caunty:,�:R_2i� r) Region1cl-R-0
Date of Visit: A,,i,.,] Time: Departure T ime: F73 3(�.
Farm Name: 0 SU�, V14�_ Owner Email:
Owner Name: Phone:
Mailing Address -
Physical Address:
Facility Contact: Title:
Onsite Representative: k
Certified Operator: Q—)—
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Gilts
Boars
Other
JE1 Other
Phone N
Integrator: -TD- m
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 =I =" Longitude: =0=1 ="
Design Current Design Current
Capacity Population WetPoultry Capacity Population
L__j El LaYeT
. ..... j ILI on-Layei
Dry Poultry
El Layers
El Non -Layers
El Pullets
D Turkeys
El Turkey Poultsl
10 Other I
I EEI
Dischar2es & Stream Impacts I
1. Is any discharge observed from any part of the operation?
Discharge originated at� 0 Structure El Application Field El Other
a- Was the conveyance man-made?
Cattle
Design- '�'�C rrent.�-e
Capacity PopulaPon. .
Dairy Cow
Dairy Calf
El Dairy Heifej
El Dry Cow
El Non-DaiTy
El Beef StockCT
El Beef Feeder
El Beef BTOod Cowl
Number of Structures:
ELI,
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?
I=
;I
Elyes P No El NA [I NE
El Yes
El No
FNA
El NE,
El Yes
El No
Ea NA
[I NE
El No )DNA
El NE
El Yes
Ej Yes
'R No
El NA
El NIE
E]Yes
E]No
RNA
EINE
12128104 Continued

—I
FaciIjity Numb7� Date of Inspection
Waste Collection & Treatment
4- Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
C
El Yes
o [:1 NA [__1 NE
a. If yes, is waste level into the structural freeboard?
11 Yes
No [:INA El NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway? -
Designed Freeboard (in).
Observed Freeboard (in): ZA
5. Are there any immediate threats to the integrity of any of the structures observed?
E] Yes
No [] NA NE
W
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
El No 0 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
T Do any of the structures need maintenance or improvement?
E]Yes
[] No El NA ArLD NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
El No El NA Jid NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
E]No El NA YtNE
maintenance Or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
C-1 Yes
El No El NA NE
maintenance/improvement?
11. Is there evidence ofincorrect application? Ifyes, check the appropriate box below.
El Yes
El No El NA NE
El Excessive Ponding 0 Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[I PAN EIPAN > 10% or 10 lbs El Total Phosphorus El Failure to incorporate Manure/Sludge
into Bare Soil
El Outside of Acceptable Crop Window El Evidence ofWind Drift 0 Application Outside
ofArea
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?
El Yes El No
El Yes[:] No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detertnination?E]Yes [:1 No
17. Does the facility lack adequate acreage for land application? 0 Yes El No
18. Is there a lack of properly operating waste application equipment? 0 Yes 0 No
• NA PNE
• NA ;ENE
El NA P NE
E] NA f;,NE
[INA NNE
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):
CL
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Confinued

FaSA Number% Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes., is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
El Yes �No E]NA EINE
El Yes P No [I NA D NE
Structure 5 Structure 6
5. A -re there any immediate threats to the integrity of any of the structures observed? [:1 Yes W No EINA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes [I No E] 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 tht�ai,- notify PWQ
7. Do any of the structures need maintenance or improvement? [:1 Yes El No 0 NA jig NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes El No El NA .0 NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes 0 No El NA 1ANE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes [:1 No [3 NA 0 NE
-.4naintenance/improvement?
11. Is there evidence of incorrect application! If yes, check the appropriate box below. [-I Yes (D No [3 NA 1� NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
El PAN Ej PAN > 10% or 10 lbs El Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
EJ Outside of Acceptable Crop Window 0 Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
El No
E] NA
>NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
El No
NA
C�tNE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?F—1 Yes
El No
NA
P NE
17- Does the facility lack adequate acreage for land application?
1:1 Yes
0 No
NA
P�NE
18. Is there a lack of properly operating waste application equipment?
El Yes
El No
El NA
AN'E
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better expWn situations. (use additional pages as necessary):
W LCO-A'i C'4ze 6k,_
Reviewer/InspectorNarne Phone:
Reviewer/Inspector Signature: Date: 0::7
1z"O/vIf Uo"Itnueu

Facility Number:'�,�:;;�I% Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [jYes [I No EINA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes [j No El NA NE
the appropirate box. E3 wup [:1 Checklists El Design [:1 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [:] No [:1 NA NE
El Waste Application El Weekly Freeboard El Waste Analysis D Soil Analysis [I Waste Transfers El Annual Certification
[3 Rainfall El Stocking El Crop Yield El 120 Minute inspections 0 Monthly and I" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a min gauge?
El Yes
0 No
0 NA
3 NE
23. If selected, did the facility fail to install and maintain rainbreakers. on irrigation equipment?
0 Yes
0 No
El NA
NNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
El No
[3 NA
PNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
El No
El NA
P9 NE
26. Did the facility fail to have an actively certified operator in charge?
0 Yes
[I No
[__1 NA
NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[I No
[:1 NA
NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
E] No
El NA
c-ANE
9W
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
E] No
[:1 NA
P9 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
El No
El NA
10 NE
If yes, contact a regional Air Quality representative immediately
r
3 1. Did the facility fail to notify the regional office of emergency situations as required by
Yes
No
[:1 NA
NE
General Permit? (ie/ discharge, freeboard problems, over application)
32- Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
0 Yes
[I No
Ej NA
NE
33- Does facility require a follow-up visit by same agency?
[I Yes
El No
[:1 NA
UNE
Comments and/or Drawings:
12128104

,�],Fgt lity Number:?,- Date of Inspection
-)L
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El No El NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 0 No D NA NE
the appropirate box. El WUP El Checklists El Design [:1 Maps E3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes [] No [:1 NA E9 NE
El Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
0 Rainfall El Stocking El Crop Yield D 120 Minute inspections El Monthly and I " Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
[I Yes
El No
[I NA
ONE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
D No
C1 NA
NNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
El No
[I NA
N NE
25�
Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
El No
[I NA
01 NE
26.
Did the facility fail to have an actively certified operatOT in charge?
0 Yes
[] No
El NA
NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0 Yes
El No
[],NA'�'
$,NE
Otherissues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
El No
EINA
1�1)NE
29-
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E]Yes
El No
EINA
99 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?
E]Yes
El No
DNA
NE
P
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
E]Yes
El No
E] NA
NE
General Permit? (ie/ discharge, freeboard problems, over application)
I
32,
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
El No
El NA
NE
33.
Does facility require a follow-up visit by same agency?
El Yes
El No
EINA
NE
lAdditional Comments and/or Drawings:
12128104

RDivision of Wat afl-
1% ===aFHff1i t y N 1 5?2- ME Z R Q, Divisio on
J:_ no R. tiN
FType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Ryepe 0 for Visit @ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
a on
Date of Visit: Arrival Time- Departure Time. Countv: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 0L_1;;?3 . Title: Phone No:
Onsite Representative: 5L4 Integrator: co ka t, I -
Certified Operator:
Back-up Operator:
Location of Farm:
swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Operator Certification Number:
Back-up Certification Number;
Latitude: =0 =' =" Longitude: = 0 = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
El Laver I I
Non-Layet
Other
Other- J1
Dry Poultry
[__1 Laxers
El Non -Layers
El Pullets
0 Turkeys
El Turkey Poultsl
El Other
I
DischaMo & Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Cattle
Design - Curreht,�,�:','-:
Capacity Population
El Dairy Cow
I
El Dairy Calf
I
El Dairy Heifei
0 Dry Cow
El Non -Dairy
0 Beef Stocket
El Beef Feeder
El Beef Brood C
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 discharae 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?
El Yes [A No 0 NA El NE
El Yes
No
0 NA
El NE
Yes
No
0 NA
El NE
El NA
0 NE
El Yes
No
0 Yes
[9 No
El NA
El NE
0 Yes
14 No
El NA
El 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? El Yes No El NA El NE
a. If yes, is waste level into the structural freeboard? Yes No E] NA [I 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? El Yes [4 No El NA El NE
(ic/ large trees, severe erosion, seepage., etc.)
6. Are there structures on -site which are not property addressed and/or managed D Yes 1% No El NA 0 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? El Yes CM No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes [A No [__1 NA El 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 El Yes 0 No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks� or compliance alternatives that need Yes M No 0 NA [.1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 23 No El NA 0 NE
[I Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
OPAN [:IPAN>10%orl0lbs El Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Cvy-Aj o 6,ca j
13. Soil type(s) NO rA Aabys L41a I rr A'l e�'o Ids-ib;-n
14. Do the receiving crops differ from those designated in the CAWMP? El Yes 9,1 No E) NA El NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes 21 No El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' El Yes KNo El NA El NE
17. Does the facility lack adequate acreage for land application? El Yes (*No 0 NA [3 NE
18. Is there a lack of properly operating waste application equipment? [I Yes Q�No El NA El NE
Reviewer/Inspector Name
­­mv ­ (9/ 0)
Phone:
Reviewer/Inspector Signature: Date: /0 —
12128104 Condnued

Facility Number: Date of Inspection If —Al —API
ReQuired Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? Yes rt No [:1 NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 1P No [:1 NA El NE
the appropirate box. El WUP El Checklists 0 Design 0 Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. El Yes rM No El NA El NE
L-F
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis [:1 Waste Transfers 0 Annual Certification
El Rainfall 0 Stocking E]CropYield [:1120 Minute Inspections Ej Monthly and I " Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[I Yes
$ No
E] NA
E] NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
EA No
0 NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
El Yes
C:1 No
M NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[I No
N NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
[_1 Yes
[Z No
C3 NA
E] NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[_1 Yes
0 No
El NA
El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes IM No [:] NA [—] NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
00 No
El NA
D 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
No
El NA
0 NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
No
[:1 NA
[I NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
No
[:1 NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
IN No
0 NA
El NE
tf. A�
61
12128104

Type of Visit & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other (:] Denied Access
-a Arrival Time: Departure Time: Countv: 5ciLkmP.S!P&-) Region:
Date of Visit: 115'L
Farm Name: 0 5 w i Owner Email:
Owner Name: C� 14 \ V Phone:
Mailing Address: !U4ZI
Physical Address: 44 19 D C, k1_ I
Facility Contact: Title: Phone No:
Onsite Representative: !2�,AUItaa, ZCJA.A).�t IS- cUntegrator: cc� k4s X lk
Certified Operator: SL_%
�2k --I:,V-. 0 — Operator Certification Number: -7 q
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I = 11 Longitude: [=1 0 =I = 11
Design Current Design Current
Swine Capacity Population wetpoultry capacity Population
10 Wean to Finish
El Wean to Feeder
Feeder to -Fln is I so -7
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
1:1 Boars
Other
El Other
El Layer
Non-Layei
Dry Poultry
11 Layers
El Non -Layers
El Pullets
1:1 Turkeys
El Turkey Poults
ID Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at- El Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
Design tdiriii C�
Cattle Capacity: Population
El Dairy Cow
I :J
El Dairy Calf
I
El Dairy Heifej
El Dry Cow
El Non -Dairy
El Beef Stockei
El Beef Feeder
El Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters ofthe 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?
0
El Yes [M No El NA D NE
El Yes
0 No
El NA
El NE
Ll Yes
El No
D NA
El NE
El NA
El NE
El Yes
El No
[:1 Yes
[jd No
0 NA
[] NE
E]Yes
XNo
[:INA
[__1NE
12178104 Continued

FaeffityNtillaber: 9,L—,79,2
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
10 No
0 NA
El NE
a� If yes, is waste level into the structural freeboard?
Yes
0 No
0 NA
[I NE
Stiructure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): R C". I
Observed Freeboard (in): S 57
5. Are there any immediate threats to the integrity of any of the structures observed?
[I Yes
[55 No
E:1 NA
[:1 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
[B No
[:1 NA
El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate pubUc health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Oa Yes [-I No C3 NA C1 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:1 Yes
[]&No
0 NA El 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
[:1 Yes
M No
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
Qj No
El NA 0 NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
[Q No
El NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
EIPAN EIPAN>10%orl0lbs []Total Phosphorus [I Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of
Area
12. Crop type(s) L'L
13. Soil type(s) A 1kh, 13
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
[A No
0 NA El NE
15. Does the receiving crop and/or land application site need improvement?
[:1 Yes
7No
[-I NA [__1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
E] Yes
5� No
Ej NA El NE
17. Does the facility lack adequate acreage for land application?
El Yes
EX No
El NA 0 NE
I& Is there a lack of properly operating waste application equipment?
El Yes
EU No
[-I NA El NE
7- Reckiooe- L­o-dy '"-� Iff- 7 VD&J,
W + vO 6 ly e- of .5 0 0,:2,*--
Phone: 17ja q(r4 IS -I(
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: "s- j as-
12128104 Condnued

Facility Number: S,,2 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes [9 No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes (11 No El NA I--] NE
the appropirate box. El WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. El Yes (A No El NA El NE
[3 Waste Application D Weekly Freeboard El Waste Analysis D Soil Analysis El Waste Transfers El Annual Certification
EIRainfall E]Stocking []CropYield 0 120 Minute Inspections El Monthly and V Rain Inspections E]WeatherCode
22,
Did the facility fail to install and maintain a rain gauge?
El Yes
9 No
[:1 NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
R1 No
El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
El No
El NA
N NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
El NA
29 NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
FX] No
[] NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
El Yes
El No
[:1 NA
(9 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
Yes
Ul No
[] NA
NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
Ep No
El 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
[� No
El NA
E:1 NE
If yes, contact a regional Air Quality representative immediately
3L
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
[29 No
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
W No
0 NA
El NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
[n No
El NA
El NE
rn m e n t s a n io r D r 8'W fi g s:'
12128104
12128104

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint .O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number g Date of Visit: 3' �7 U Time:
O Not Operational O Below Threshold
M4rermitted Q-115irtified © Conditionally Certified 0 Registered Date -Last Operated or Above Threshold:
Farm Name: -- County: =�g=&A t3Fit p
Owner Name: -5 "�� Phone No:
Mailing Address: ors__. _ 1V G_- --- �
Facility Contact- Title: Phone No:
Onsite Representative: „� /�' �w fir.. �( Integrator. C_a_AAe k F ift c
Certified Operator. _ _ Operator Certification Number:
Location of Farm:
M.6�ne ❑ poultry ❑ Cattle 0 Norse Latitude ' 4U Longitude •
De rgn Curet I?ig iCurresi. :Degu hCzd_raat -
Somme Po tion ,; PoW3J' Po on Cattle f:on
rGflts
o Feeder Layer Dairy -
s
to Finish 2,1 po Non -Layer Non -Dairy
to Wean
�.� Other to Feeder
to Parish
Totai'Dedsgt9
t "-1 T©tal':W
Nmnber a# :L-agoons �
Un
w _
Disc es & Stream paw
I. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
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
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notifv DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure b
Identifier:
Freeboard (inches):
12112103
Continued

4
IFacility Number:
0 — I
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [I Yes [j No
seepage, etc.)
6. Are there stn2ctures on -site which are not properly addressed and/or managed through a waste management or 0 Yes El No
closure plan? (If any of questions 4-6 was answered yes, and the situation poses an
immediate public hegdth or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement? 11 Yes [D No
8. Does any pan of the waste management system other than waste structures require maintenancerimprovement? El Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level 0 Yes 0 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerimprovement? 0 Yes 0 No
11. Is there evidence of over application? If yes, check the appropriate box below. 0 Yes 0 No
0 Excessive Ponding, 0 PAN 0 Hydraulic Overload 0 Frozen Ground 0 Copper and/or Zinr
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNP)? 0 Yes 0 No
14. a) Does the facility lack adequate acreage for land application? [] Yes 0 No
b) Does the facility need a wettable acre determination? 0 Yes 0 No
C) This facility is pended for a wettable acre determination? 0 Yes El No
15. Does the receiving crop need improvement? 0 Yes [j No
16. Is there a lack of adequate waste application equipment? [I Yes [:] No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [3 yes ONo
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? 0 Yes [I No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes ONo
roads, building structure, and/or public property)
C2
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional 0 Yes 0 No
Air Quality representative immediately.
Ab
See- A&A� "0
L? r
er/In ftme
Re,dew, 7-
qwtor N
RevieweriLmspector Signature: Date:
12112103 Continued

0 1 Faj=t—y Number., V —,2,ga I Date of Inspection
Required Records & Tsocuments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
0 Yes
El No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iet VAT, checklists, design, maps, etc.)
[:1 Yes
[I No
23. Does record keeping need improvement? If yes, check the appropriate box below.
C] Yes
[I No
E] Waste Application E3 Freeboard [] Waste Analysis [I Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 Yes
El No
25. Did the facility fail to have a actively certified operator in charge?
[I Yes
El No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
[:I Yes
0 No
27. Did ReviewerAnspector fail to discuss reviewlinspection with on -site repres entative?
El Yes
El No
28. Does facility require a follow-up visit by same agency?
0 Yes
[I No
29. Were any additional problems noted which cause noncompliance of the Cxxdfied AWMP?
0 Yes
[I No
TN'FDES Permitted F2cilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
0 Yes
[3 No
31- if selecte4 did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
13 No
32. Did the facility fail to install and maintain a rain gauge?
0 Yes
[:] No
33. Did the facility fail to conduct an annual sludge survey?
E] Yes
[:3 No
34. Did the facility fail to calibrate waste application equipment? El Yes [I No
35. Does record keeping for NPDES required forms need unprovement? If yes, check the appropriate box below. [I Yes F-1 No
[] Stocking Form [:] Crop Yield Fom [3 Rainfall [3 Inspection After 1 " Rain
0 120 Minute Inspections 0 Annual Certification Form
12112103

Site Requires Irmmediate Attention:
Facility No. Fi'�i_ -
DivimN OF ENVMONUENTAL MANACAaAENT
ANUAAL FEEDLOT OPERATIONS SrM VISITATION RECORD
Farm Nwne;/Owner
DATE. '25 / \ -, 1995
Time: to :5,C.7
7 D M 1-6 Gu kk'k\JGY%
Q0bQ_'4 OdJes
Mailing Address: LA �O k 5 Co*��&4ar-�,_\J'A\Q_ �k& FG:k Son I n C, -31-4
County: -Sam 0so n
lut,,Mtor. TDm F,,.,s-- Phone. 2&,.0 -CQJI.
On Site Representative:Tp m- Fca,,-.x Phone: T0:5Jq'-QQ(1
Physical Addres0-ocadon: 17
2(.- Pj_
Type of Operation: Swine E% " Poultry . (�atdc _
Desip Capa6ry: .2 j f[2 T�c cd I F o­ Nwnber of Animals ort Sim:
F
DEM Certification Number: ACY-2— DEM Certificamon Number. ACNEW_
L.Wtude: 8 SU * 1-16-1 " - Longivade: 1v n ' /I '%jj 3"
Circle Yu or No
Does the Animal Waste Lagoon have sufficient fi:eeboard of I Foot - 25 year 24 hour storm event
(approximately I foot + 7 inches) Yes or No
Was any seepage observed frorn ft lagoon(s)?
Is adequate land available for spray?
Crop(s) being utilized: C_o�
or No
I-- C:.Lr ^� -S
Actual Freeboard: _ff—Ft. -2- U=hcs
9
Yes a ONO Was any erosion ob Yes 09�F)
Is the cover crop A—.--.
. Yes
?7; No
Does die faciliEy meet SCS nii�ur_i wback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells? Y or No
750 N_'(
Is the animal waste stockpiled within 100 Feet of USGS Blue Line SLream? Yes o CN)o
Is animal waste land applicd or spray irrigated within 25 F= of a USGS Map Blue Line? Yes orS)
Is animal waste discharged into waters of Ehe state by man-made ditch, flushing system. or other
sim.ilar man-made devices? Yes or6:) If Yes, Please ExpLain.
Dom; the facility maintain adequate waste management records (volumes of manum, land applied,
spray inigated on specific acreage with cover crop)? Yes or No
Additional Comments: ] L-1 ck- y !�j Sr
�' J" R__ k \_�-) - C-V- '__ ir
pector Name
--U%- CD\� C-A
Signature
cr-: Facility Assessment Unit Use Attachments if Needed.

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 sheep, 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 DEM. Please print clearly.
Farm Nam6: '5\'U'!r\ Q_
Mailing Address:- Rt 5.1*-�x 'qC
county:
Owner(s) Name:
manager(s) Name:
Lessee Name:----.
-7
Phone No. $Cl-­57�L
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.): 5 P_ Cz a-Ce- - LY-21-L ic VJ- .
Latitude/Longitude if known: QB,�P -#.
Desian capacity of animal waste manageme t
system
(N mb
and type
of C�n'fined animai(s))-__
Avera'ge animal population on the farm (N luber angi type of animal (s)
raised) : 124�:C k 11'�. GU-- to 4i'l-SL
Year
Production Began: /5"11 ASCS Tract
No.
Type
of Waste Management System Used:
LenElocn
Acres Available for Land Application of Waste:
Owner (s) Signature (s) :
TE : 11_A�1_3_
DATE: