820283_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai

iypu u, visit: we-tr.ompuance inspection v tpperatnon meview 1.1 ,tructure r vaiaatton v t ecnnicai ,assistance I
Reason for Visit: Q'Itoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: lof I Arrival Time: ¢/ Departure Time: County: Region:
1
Farm Name: c.C6,
ct r—'re,ic.-,_ Owner Email:
Owner Name: 1c Phone:
Mailing Address:
Physical Address:
Facility Contact: JQ-e 4 f `id LTitle:
Onsite Representative: # f
Certified Operator: t 1
Back-up Operator:
Location of Farm:
Phone:
Integrator: Ja er'k --t _
Certification Number: kD q31
Certification Number:
Latitude: Longitude:
Design
Current
Design
Current
_ Design Current
Swine
Capacity
Poi _:. Wet Poultry
C0.2 at
ERROackty Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Atoo
--=
Daia Heifer
Farrow to Wean
=
Design
Current £ '
Dry Cow
Farrow to Feeder
Dr P,oul Ca aci P,o k
Non -Dairy
' Farrow to Finish
Layers
lff
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
-
Beef Brood Cow
Turkeys
Other
... ,
Turke Poults
Other Other
Discha es and Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ g.Alcr—❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [3-No
❑ Yes EJ No
[?--A ❑ NE
[f NA ❑ NE
[][-NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

acility Dumber: - Date of inspection:
e
r
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®-A}a--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D_D 'A— ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3�No, ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
To_
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E' 1go
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�
❑ 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
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
❑ NE
13. Soil Type(s): )a.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes /�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ jA4o ❑ 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 [2rNo ❑ NA ❑ NE
[:]Yes [ -No ❑ NA ❑ 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
❑ Yes Q,pda
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑'l�lo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes A�yNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes allo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

eadlity limber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []-1'16­ ❑ NA ❑ NE
25. Is theYacility out of compliance with permit conditions related to sludge? if yes, check [] Yes [J'NO ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? r] Yes NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2-1 o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[Z0fa
❑ 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
B<O
❑ 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
Q No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D]No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E]�N_o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[1 io
❑ NA
❑ NE
Comments (refer to question #) �Ea<plam�any�YES�ansvrers`�andLor any additional recommeadations�or any,�other-comments.
Use drawuigssoftfacifity toLbetter"� explain sitnahonsE;(�se addihonal pages as necessary,) .,� S>�' �.
C-cul&4- Z- �-� - (7
__ i L 4�
C-e y I fC»
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:"
Date: ail
21412015

ivi`sion of Water Resources
Facility Number - ® ® Division of Soil and Water Conservation
OQ Other Agent}'
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: m Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:IT�d'(. I Departure Time: County:S-4 KrRegion:
Farm Name: �Qv A,�Cy� Owner Email:
Owner Name: �r Phone:
Mailing Address:
Physical Address:
Facility Contact:
t°r
Onsite Representative: ff
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: P-6/1 11 p I�
Certification Number: U T+�I
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Ca#tle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
D . P,oultry
Design
Ca acity
Current
P.o
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Jrr
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
L10ther
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[]Yes 0 ❑NA ❑NE
[:]Yes [:]No P-NA ❑ NE
[:]Yes [:]No EfrNA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [?T NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rO No DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ -Yes E!f No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faci i Number: Date of Inspection:
• Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q_No- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ®.3-t'A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ED-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 [v]'i'lo
❑ 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 environm tal threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
es Jallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [/TNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes [ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes [ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside ofAcceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V�'A,� :5J'�GKV �9 59'rhrlr
Q"
t
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes hTo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LT10 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E5"No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections,
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�lo
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

Facili Number: Date of Inspection: --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OG No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ej3�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2"'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Ca o ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes O-No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EB"No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo ❑ NA ❑ NE
Comments,(refer to .question #) Explain any::YES answers and/or any additional recommendations or any others comMttents:
Use drawings of facility to .better expfatnMtuations'(use additional pages as,necessary).
c,�Q f7
jt7 t�," C,, 1, 1 S 4k 0 f q, 2� 7..;;,00V**_' 6e"C'k,
C_fei T1D- _ 5
Reviewer/Inspector Name: �� Phone:
3 Reviewer/inspector Signature: Date:
Page 3 of 3 21412015

�Iw, 4 0 V-,� 1� -�b
Structure Evaluation Inspection
Facility Number: -- Z83
Date: I M
Time in: /'l,(' lS Time out:./ ,3y
Farm Name: AA 1 hc�&�t Farm 911 address:
Owner Name: Jt bte,_r6nh Phone
Facty Contact: i!
Onsite Representative:
K
Integrator: hJ'{j
Certified Operator: h Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No
Was non -compliant level reported to DWR POA received
Structure: 1 2 3 4 5
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): �3
Are there any immediate threats to the integrity of any of the structures
observed? Yes No V-11-
R
Do any structures lack adequate markers as required by the permit? Yes — No ✓
Does any part of the waste management system need repair Yes No
Condition of field's laic
Condition of receiving crop
Comments:

1 $ )z r M'q m And-.1 l 6
7z
Type of Visit: GCompliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: y rival Time: Departure Time: County: s Region:
Farm Name: ^�"�l iti(- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 6es B
Certification Number:
Certification Number:
Longitude:
esign Current
Design
Current
Design Current
pacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
inish
Layer
Dai Cow
eeder
Non -La er
Da' Calf
tMED
inish
fl
.
Da' Heifer
Wean
IN
Design
Current
Cow
Feeder
De. P.oul "`
Ca aci
Pia .
Non -Dairy
Finish
La ers
Beef Stocker
Boars
Non -Layers
Pullets
Turkeys
Beef Feeder
jBeef Brood Cow
Uther
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field
a. Was the conveyance man-made?
❑ Other:
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [kj ~ ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZrTqo
❑ Yes ZNo
E'RA ❑ NE
Q NA ❑ NE
�NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3
21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes �_ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No B'1GA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
gK
❑ 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
fa o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q'fFo
DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
t�
maintenance or mprovemen .
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CleNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approve Area
r, r7 4 n li . 1 i .t n -.
12. Crop Type(s):
e
i ✓
13. Soil Type(s): /A)^-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [TNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ Yes E No
❑ NA ❑ NE
❑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 ENo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes 0No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [r, No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection: ,._
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [+]'�fo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D "'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [54o ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes EfNo ❑ NA 0 NE
❑ Yes Eno ❑ NA ONE
❑ Yes [�No
❑ Yes [n No
❑ Yes eNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES, answers and/or any additional-recommendabons or any other_ comments_: y
Use drawings of facility to better explain situatiRi;(use additional pages as necessary):
5LA t Y, 9,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3 3' 3
Date: J�
21412014

S w
Type of visit: to comptiance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
�Date of Visit: u Arrival Time: � Departure Time: ! County_
Farm Name: /� �T'�".-Ownear Email:
Owner Name: t( Phone:
Mailing Address:
Physical Address:
Region: W
Facility Contact: tom` D Title: Phone:
Onsite Representative: ( Integrator: L_" _
Certified Operator: i�G� f iu"c IM'4(' Certification Number: 1, b 43
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poulhy
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
t{
D . P,oul
ILavers
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Design
Ca a '
Current
P,o
Dairy Heifer
Cow
Non-DaiTy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
. ❑ Yes ❑'No ❑ NA ❑ NE
[:]Yes ❑ No Q A ❑ NE
❑ Yes ❑ No C JN-Ar` ❑ NE
[:]Yes
[:]No
lA
❑ NE
❑ Yes
C]No
❑ NA
❑ NE
❑ Yes
E: No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Nnmber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No NA ❑ NE
a. If yes, is waste level into the structural freeboard? [-]Yes [:]No [r] N7 ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Enk?g5 ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
;
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
t d l` o
0 NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
[:]No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C .4f1 L Jr/�� �r /�C3+c Sa =
13. Soil Type(s): +�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[BNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
l-1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
LE14o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [�No
❑ Yes [�fNo
[:]Yes Eg'<o
❑ Yes [JNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes CK40 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F:(No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: z Date of Inspection: et{ _
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes E�<o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes to
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes fo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [TI�o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
[:]Yes FB/No ❑ NA ❑ NE
Comments refer to 9 ) P _. .. y r . - Yy . .. any other comments .
:.YES-ryj. ons or -=� -
Use raw
;
ommeW,ngs of facility to better explaut�s,tuahons {use addittonala a es as neces $�ommen ate #4} r
_ gip. g ..
�Cr�- 3 H3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Zeason for Visit: QrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �r , Arrival Time: Departure Time: � County s Region?
Farm Name: �vC Owner Email:
Owner Name: !( Phone:
Mailing Address
Physical Addrem
Facility Contact:
Onsite Representative: I t Integrator:
AT
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design went
gn Current
Design Current
Cap achy Pop.,
Wet PoulMQesj
apacity , Pop Cattle .
Capacity Pop.
ry_a ......:
.
Finish
7FEeder
La er Da Cow
Non -La er
DairyCalf
Feeder
-
D"e�Zi�Tnlitrrent
2Ltry Heifer
o Finish
Farrow to Wean
D Cow
Farrow to Feeder
D , P,oul Ea ePo
Non -Da
Farrow to Finish
Layers
-
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
�t
Other - '
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[g'<o
❑ NA
[] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
Q�VA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[L-116
❑ 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
E14qo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�o
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. IS storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ®-Mo— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C3-N1r-- ❑ NA ❑ 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 P-N—o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3 o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C3 N ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind
Drift / ❑ Application Outsides of Approved Area/
12. Crop TYpe(s): (' i�. I �E�f/ 'L ! iL��f'�a��/�iZt 1�-'+* d 'tit s C1>
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [D.1- ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 06 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 7L44❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes to [] NA ❑ NE
❑ Yes ZnO ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
ET�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E5�
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
'No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

lFacility Number: - Date of Ias ection: c
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [;]'Ro ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L.1J� o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [TN. ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [j No ❑ NA ❑ NE
[:]Yes ['# No ❑ NA ❑ NE
[—]Yes E ] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�No
❑ NA
❑ NE
EJ'No
[DNA
❑ NE
O/No
❑ NA
❑ NE
Reviewer/Inspector Name: j _�%1�� Phone:6L�
Reviewer/Inspector Signature:
Page 3 of 3
Date:

you B1a1h il VS
Type of Visit: `® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Pr Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
M �
Date of Visit: 1!011� Arrival Time: A Departure Time: County: Region: . —0 -
Farm Name: Ro bpft- A16 -Th(yfflo f Fbmi Owner Email:
Owner Name: R '}belt Al tri"1 T10rdon Phone:
Mailing Address:
Physical Address: L. (21 ja 1 a)
Facility Contact: RQbat Al -en T ho(AM Title: OWnW Phone:
Onsite Representative: Pabet— _D&ida -1 Integrator: pl-6)fage-
Certified Operator: ?Nitc',o -Mf1/(A� Certification Number: $ 43
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Pop. Wet PoiItry
Layer
Nan -La er
" - ' :
D ; PoW
ILayers
Design
Capacity
_
Ca aci
Current
IF
Po
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Nan -La ers
Beef Feeder
Boars
1pullets
M1
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 tj� No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ERNo
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - '3 Date of Inspection: $ j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure
4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CR No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
[] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[a No
❑ NA
.❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fRNo
❑ NA
❑ WE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CR No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s):
� 6onda,
�❑
F __ v hY� WI'►711 /iA11 1.
S%�'i'�� O�nlh
13. Soil Type(s):111
14. Do the receiving Crops differ from those designated in the CAWMP?
3V3 ® Yes
11 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
iDVS 'Q Yes
Iff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
CgNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CS No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
03 No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
tg No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
g NA ❑ NE
Page 2 of 3
21412011 Continued

lFacility.Number: $ - a
Date of Inspection:?
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 ER No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ®NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �2 No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes Co No ❑ NA ❑ NE
❑ Yes to No ❑ NA ❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
121 Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or,any,additional recommendations or any other comments. '
Use drawings of facility to better explain situations (use addrtioaal:,na¢es as necessarv)
Dftt (to fsed) hors beon duo►d 07 ) a9zi ber,,, nb7.
S reach. � amvWv4 ll Ikfl 4 leaae Cv'f' b� !tS Qf�' 1 ii` is S �f'Q
o? , P�Pc,,,o- poj-` roroi4o- of aor 1 -�i-ee bXn�s f ' ��3vrle- aert4„br�),
&M rwotldr aid aou reads ore i7
}�, 5vryle. tali- nor -��h aro� a [, Fly svlf%, PtCdvtw v i I l s
� �
shy � ' QAe- � � lihae acres Yeas zed o , *-
r � �
f y . The ova -Pf°, wos rna�, add sra ham, bUf s bps vv6�-
le��iur i�al�e al , Ailaa)e &/1
�veulo,r PAM `70 L BS1,0 car fog _hors f al4 aid-
0-7.4 Follow�v check -oo -( I� arts ,4y ad, pia, modfficaWo7.
e Vvh -h _%e_4r�wAe dal ,e- hare norms knew, 0-
CON m � , � ��
ipe. cqn -for -e 11 vvd/ k d v-e. sv/h Me-1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
wV110,MMMMI'0�
Phone: �iQ` 30 (Rt/(Y)
Date - 4�ao 13m �o
21412011 #�

Facility No. 46a d Farm Name f�[J�•�'Ai6h_holl, Date
Permit COC OIC� NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
tibia Jril<
�11,�: �^
Lagoon Name, S forspillway
1
112
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
71107
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Ring
6
, 1!------
Design Flow (gpm)
i
Soil Test Date rJ
a
Crop Yield
Transfer Sheets) �rx
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP -30 N
Dead box_ or incinerator
Lime Applied
Weekly. Freeboard
MortalityRecords
Cu-I ✓ Zn-1
1 in Inspections V,-
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
' `
iiPP--CAS P Alp-% k--- k
t
�iwww•i
.,
..
r
rll7at�f n�
/
/ >t�iJ •� �
■ .
4110 1 412� i�.
PR
ry
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records IA // I j 3
Date last WUP at farm Lagoon # 3�
App. Hardware Top Dike
Stop Pump x �� q3
Start Pump , l�j ( �
Conversion- Cu-I 3000= 108 Ib/ac Zn-I 3000= 213 lbIac
t QrS�DI �3
1p
V,$eblk upA) S 1411) �CtIf C4.
1 fM 9a-01� 106
14us-or,nI r tftim bcfk $a-xvr PrM4le-

. 1.
Type of Visit: 45 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: ` 3 Arrival Time: Departure Time: f rI County: �r Region:
Farm Name: Po ber1` Al kn lhfJl/l�l I lt(/11 Owner Email:
Owner Name: Rok7416% I f?eyofek) Phone:
Mailing Address:
Physical Address: %/`j M } pule L 1)f
Facility Contact: g �`pl?I l Title: Phone:
Onsite Representative: Integrator: RfL:A P
Certified Operator: r d ll5i'e. Thoo -ai Certification Number: 9E 6Y,3 f
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Capacity Pop... _
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,uultr
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
t)ther
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
tT No
❑ NA
❑ NE
Page I of 3 21412011 Continued

[Facility Number: a937 jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5a No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑NA ❑NE
❑ NA ❑ NE
Structure I Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?: _
Designed Freeboard (in):_
Observed Freeboard (in): C
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes E'No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fS;T'No
❑ NA
❑ NE
maintenance or improvement?
1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
�
12. Crop Type(s): Cm-61 neemc.C�0.�}�{i.lrqt`9y)C .wl i(,lot /ya)P_ Grolinso-it u,., . Kh&4—kye
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes [—]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 1�3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ta No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MI -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
C'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [S Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard. ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield 120 Minute Inspections Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes [K No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
Eg NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - a 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
El Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
® No ❑ NA ❑ NE
RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA NE
❑ Yes [] No [R NA ❑ NE
❑ Yes 0 No [DNA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
g No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
r' No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
KNo]
NA
❑ NE
FVhwvr ?P lns�e�- non ►� b eer�e�,� osf ,-�ch�rk Q� pap i (Pi-two,,t rmtt traf fib ins®c�Sb,J.
�4I1 wg o��js� w$� �6M►oa r aorl and aO la, �d wee dcie i,, a fi� 1 n�a�17
The and -,ter do i; � 1 so' I +ejf Yvar lwh � aid I hvr Ursa bt e -to
�
eaUl f � �fab�
aDll s fial retails a,d (01^h t 11 N'Plecheckey, , Hoif of 4,_ aO It -eiPebard-
r��r�dr rYe-e_ 11
agar `poi^ e YYa t dale i aaot1 c�le -10 *Pyh�, 9 a eP& rer�lr vrNN
r � � It far �
a I, p6r_ In i h`a � IQ ov, Qrd. s SN"I fnS Lhf � ) roIh 11 ��7
[if raw a e- under I `ffa-a II -eve is r
lojc0j g11-ej. Pv&e hayed ai e b
W,co- h i l ( be, [ -�kfh s of466
.1 1113V5 �.
i(,e� - N& w� p5
�Nrl� �6i' Qrar� ccoo�py
�� a abo'f, t&on etoatte- cO fr-7.
Reviewer/Inspector Name: J 004 S np i$^ . - Phone: � � 3W
Reviewer/Inspector Signature: Date: FP_ kj, cl0 (3
Page 3 of 3 U 21412011

Facility No.Farm NameDate of 10 (13
T—
Permit ;COC OICNPDES(Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S fors illway
1
2
3
4
5
6
7
Design Freeboard I Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to7reatment Volume if> 0.45
Date out of compliance/ POA?
I --. T i V I -.!'M!1r57�
--Calibration Date
-- - ---------------
Ring Size (iri)—t
Soil Test Date Lo+ 0, 1tr
PH Fields I 1)
Lime Needed sae adfi�`c�
Lime Applied
Cu-I �_ Zn I
Needs S (S-1<25) lgba Z
Needs P h e lr?ln
Waste Date'
- 60 Da i
+ 60 Da
N lb11000 Gal)! L S
H
nko-'I ,,l �l'Arn �7 1 f it t/F+Pi7R Yl
Mv9
Q0r
Crop Yield Transfer Sheets
Wettable Acres RAI GAUGE
WUP e r ' cinerato
Weekly Freeboard Ro t� ✓ o lity Recor s
1 in Inspections u0 Check Lists
120 min Insp. ;/ Storm Water
�hla��iicr rnr�cc t�
I
Uj)j-�rsp a01 b<a -IQI IDA1J 3Nj1p-1DIz-.1 y-f°d)wVXfV,1)p0VfMj11f1ry1l�r�TKvi
Verify'PHONE NUMBERS and affiliations
Date last WO FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware 3 Top Dike
Stop Pump
Start Pump
E
Conversion-jCu-1 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac
I I I UVOR— &4o,1 b,0 t6-kl-tlf$r[V(0- j'
V

pj% Uvi 9ijglja
"'Division of Water Quality
Facility Numbers - a $3 Q Division of Soil and Water Conservation
0 Maw
Type of Visit: 10 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: ' r - --� Arrival Time: 1<6 Departure Time: County:
Farm Name: C 1 7q I 'n a F(, 07 Owner Email:
Owner Name: _T�&A&l Phone:
Mailing Address:
Physical Address:
Region: f`-�
FacilityContact: 1,6it-A116h1ho(4o, Title: 6Wrjb- Phone:
Onsite Representative: Qja/I Integrator:
nn �
Certified Operator: Mop- op T'jQl/r} (n Certification Number: g86ya l
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�. urrent Design C" r•
I Design Current
Swine Capacity Pap.. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
ayer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
X
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Q490Dairy
D , P,oul - Ca acity P.o
La ers
Non -La ers
Heifer
22 Cow
Non -Da'
Beef Stocker
Gilts
Beef Feeder
01
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
r�..:
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
[—]Yes
[-]No
❑ NA
❑ NE
[-]Yes
❑ No
❑ NA
E] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes n No ❑ NA C] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes P�`No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued ,

Facility Number: Date of Inspection:,)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f>_�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �—
Observed Freeboard (in): '1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? E0 Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 12TNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Uj No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes CK No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
,
12. Crop Type(s): G26' Q 1 &, _ r�RTiP Surf a Qajad , C&n n mq,,T )DV
13. Soil Type(s): IyQALil 4 IQ
14. Do the receiving crops differ from those designated in the CAWMP? Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 'Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes &]-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 18 No ❑ NA ❑ NE
O Yes 15�No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
n No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
ICI Yes
❑ No
❑ NA
❑ NE
® Waste Application Weekly Freeboard ® Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[jRainfall [:]Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and ]" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[] No
J�j NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: qj -C1 La Date of Inspection: 1-7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ig No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CE� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Eg No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No n NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
CR No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
'�ffNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J�a No
❑ NA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
W No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
JKYes
[:]No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andlor-any additional recommendations or -,any other corriments:
Use drawingaii s of facility to better explain situations (use additional'mes' as nece' i -nV : �
i#k, n on rowcry -I r eIds ate a e )ed oct( [Tal/aue),
_7, SM0119u1111P.s a, bads d e of i ajcx ,} soi I wash -t 4xgo*& pebblf-, PIejye ��ll yvic�
��.sof��cadJ{ OrS�i� �fi1iZe !{ow, )odmvlch. A�o pleas-eer- b�,,))yja7
01-e 04fI'de co/n��' Dal sea �1 sytq. (ems , III�� �e�-
1 y A #se ha ve_YVask p1¢t mod f6Pd
�o'dLde-Mf104, 1l t'jedIaid. f
al : Goad re (ofd s -f0, �1 a , M js5- CAL
o�F r'er tad s for a 011 s n dud �
Tarecorha,dcro 9Also 161 n * A 1a o s h&ot.
� � � yr�1d. � o y `q 6 � �d
co 7 it°1 of YvasFe a�aly,rel (moils Mlsss,� `�or bdA c)o11 and ao�J
33, F0lOriv� ins Ap,7 u4414o ak 0, rxec4 Vvajk f lih mGdr cai07 q�
301)
T1I s InS [t` tai se/vej ar G�
� y
fields in 9�shgp�, u-errc�T��►s��s�`��'�in
Reviewer/Inspector Name: Z a_ SJ)twj-pr Phone: aM •AC?
Reviewer/Inspector Signature: Date: Jk r] 0 D o I a
11
Page 3 of 3 U 21412011

Facility No.,L�0))Farm Name jR0bffLYjU ' Date a (� a
Permit _ _COC OIC_ NPDES (Rainbreaker PLAT
OEM
Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Slud a Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge toTreatment Volume if> 0.45
t-
Date out of oorri liancel POA?
Design D-Actual
Diam.
Soil Test Date Crop Yield
pH Fields i Wettable Acres
Lime Needed LT_ r'"''°� WUP��
Lime7kpptied7� Weekly Freeboard
Cu-1 ___L/Zn-I 1 in Inspections
Needs S (S-1<25) „ 120 min Insp.
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
[f�l�--_------
ELOUF in E.
.
..
, .
■
Mill MK��
MA
Ven yf- PONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware i Top Dike
Stop Pump
Start Pump
SwrA,Xj- pig U a pf6- f ns�Pcii �
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Ib/ac

Type of Visit Q-em-ppliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 010utine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: ri ccen.�� Owner Email: QLt":23. r
Owner Name: d �� Phone:
Mailing Address:
Physical Address:
Facility Contact: / Tit]
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = 1 = u Longitude: = c = + = 1i
Design
Current
Design Current
Design Current
Swirte
Capacity
Popul Lion
Wet Poultry Capa�ty Population
Cattic Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
1110
Non -Layer
❑ Daia Calf
ELFeeder to Finish
Z/ 9"
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cod 1 1
❑ Turkeys
Other
_.
❑ Turkey Poults
UOther
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
WNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ANo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
`
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? El NA [I NE
❑ Yes ®No
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 91 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? RYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
EKNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
9[No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
21-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > i 0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift [:]Application Outside of Area
%Window
12. Crop type(s) Z2f`tx_,L!
13. Soil type(s) Q) 0—F
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
B�NO
❑ NA ❑ NE
15- Does the receiving crop and/or land application site need improvement? ❑ Yes
WNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
&No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
JZ No
❑ NA ❑ NE
Reviewer/Ins ectorNamc '`�r ,'
p,a�k'. Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ca No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
FLNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XLNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5.No
❑ NA
❑ NE
12128104

Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: Arrival Time: v.' D D Departure Time: ?� County: �Region:
Farm Name: A—✓t•'L' «'"` Owner Email:
Owner Name: ^� a<� s�{��rr1''~� Phone:
Mailing Address:
Physical Address:
Facility Contact: NOA22 2fa'iz� 6 � Title: e/ Phone No: & &0 L �a
SL
Onsite Representative: 9 Integrator: ���::/,
Certified Operator: Operator Certification Number:�� y�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=] e 0 ' = u Longitude: = ° = ' = "
Iffim
Design Cnrrent
Design Current Design Current
Swine
Capacity Population Wet Poultry
Capacity Population C►attH Capacity Population
❑ DairyCow
❑ Dai Calf
r to Finish
�t7 3
; . ❑ Dai Heifer
w to Wean
:Dry Poultry
`- " ❑ D Cow
to Feeder
' °
❑Non -Dairy
to Finish
E
` ❑ La ers
❑ Beef Stocker
❑Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Turke s
_ ❑Turke Points
❑Other
Number of Structures
to Finish
to Feeder
� ❑Non -La er
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
5�No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
[I Yes
❑ No
❑ NA
❑ N>;
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
®.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
[&No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: Date of Inspection T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [H-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ®.Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CirNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®No ❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) . �'r v�r��.�d I Brrl�/G-� / ep/A
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�LNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0, No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question ##) Explain any YES ,answers and/oir any,recommendatj'onsvr'or any other comments.
Use drawin s'of faciti to..6etter ex: `lain situations.. use addit,o' g .M �" `
g t} p ( nal. a es as necessa ' 1k .:
J3. aFoflow - (,-,p L) ', F. ua,�j 7 '07A e/K.e- ivotk'o,
Reviewer/Inspector Name , D- & Phone: 3 3CrC>
Reviewer/Inspector Signature: Date:

r
I` Facility Number:-- Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 [.No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
. ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ea No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
5;No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E,No
❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®,No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R) No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
,Yes
XNo
❑ NA
❑ NE
12128/04

Type of Visit Q'�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time:
.�flD
Departure Time: '/ County. r-- Region:
Farm Name:
cd Adon
�Y Owner Email:
Owner Name:
et^t /�1
rr
I +en.
A 0 yr���^`� Phone:
Mailing Address:
Physical Address: Q —rf
Facility Contact: / D r P>/i2� e: Phone No:
Onsite Representative: Integrator:.'T�/��—
Certified Operator:4Operator Certification Number: ��� y3
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =c =' [� « Longitude: L�] o = "
'. Design Current Design Current _'
Design
Current
5wmeCapacity Population Wet Poultry Capacity PopulateonCattle
Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er ❑ Dairy Calf
F ❑ Dairy Heifer
T:n ❑ Dry Cow
Dry Poa.ttry - k
''`�
Feeder to Finish
7CU7.
❑ Farrow to Wean
❑
Farrow to Feeder
�' ❑Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers [] Beef Feeder
❑ Boars
El *g❑ Beef Brood Co
❑ Turkeys
Other....
_
❑ Turkev Pouets
❑OtherNumber of $t;uctures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JWNo ❑ NA ON I,
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'j _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [SZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ZNo ❑ 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 NA NE
maintenance or improvement? El Yes [�No El NA
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 19 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil e s
type(s) () 1,C1a Z
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ERNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
I.No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
R .No
❑ NA
❑ NE
Reviewer/Inspector Name �� _ _ phone: 9/D-1.�•33D27
Reviewer/Inspector Signature: - Date: g"p�,eia

Facility Number: Date of Inspection d'
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [9No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Pq No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EffNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes P No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
My
❑ NA
Cl NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
09 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
5q No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
._:
Additional Comments and/or Drawings
,..�� N��� �-�`" �� µ �
�.. _ n
f
Page 3 of 3 12128104

ivision of Water Quality
Facility Number �3 O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 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 ❑ Denied Access
OR
Date of Visit: `/ - Arrival Time: ; % Departure Time: 13 O County•. �"` Region:
Farm Name: �K`- Owner Email:
Owner Name:-RIlk Iff-t /¢//C2 �r-sr Phone:
Mailing Address:
Physical Address:
Facility Contact: 1� 0h,—r� � Q r_A t&--Title:
Onsite Representative:
Certified Operator: f c e __ E
Back-up Operator:
Phone No:
Integrator:401
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 ' = u Longitude: a ° [=] ' = «
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Nan -La et
❑ Wean to Finish
❑ Wean to Feeder
Rj Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Ul
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �&No ❑ NA ❑ NE
❑Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
JgNo
❑ NA
❑ NE
12128104 Continued

r
Date of Inspection
Facility N umber:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
tA No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4.6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
[&Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[$No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes
[$No
❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[Z No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
[SNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12 _ Crop type(s)
13. Soil type(s) �� R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ER No
❑ NA ❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
CgNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
10 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
0 C: 'pa-? bl-h i ny � � �On d' -To
11,16
u/ier � f/ of �� ��t (�ijt�c-C�� : � � Gc�Y � � rl> s �P
�pu i�s�� 3
Reviewer/Inspector Name r Phone: g/J -�33 33nti
Reviewer/lnspector Signature: Date:
1 "/10/V1i %-Ulgills"C"

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

n
Type of Visit Z)�Cbmpliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: lv- Arrival Time: .,.�!�Q%j� Departure Time: . OO County: Region:r
Farm Name: Owner Email:
Owner Name: O� �+ft t]�/Z fD ��- Phone:
Mailing Address: 321D key e-of- >'� vd CrL;.fie A, /` e
Physical Address: L
Facility Contact: ey-7 ___ 7'Ad n717 `Fitle: Phone -No:
Onsite Representative: z-,�--e Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� n [= [� u Longitude: = o = g =
CA
Design Current Desigr
rrent Design Currulation
Wet Poultry Capacilatiou Gattte Capacity Population11
❑ Wean to Finish
❑ La er
❑Dairy Cow
❑ Wean to Feeder
I JE1 Non -Layer
I
airy Calf
Feeder to Finishbw�o
S'
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry El Dry Cow
ElFarrow to Feeder E]Non-Dairy
❑ La ers
❑ Farrow to Finish ❑ Beef Stocker
on -Layers
❑ Gilts El Beef Feeder
El Pullets
❑ Boars ❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Puults
❑ Other 10 Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
UQ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ANo
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
Q�_No
❑ NA
[:IN E
12128104 Continued

Facility Number: - Date of Inspection r 6
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): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes R[,No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,( No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate pubflc health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Z-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes r-4 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RkNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
2Q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JKNo
❑ NA
❑ NE
werl 0--v /� � �Grc�al�Ic
Reviewer/Inspector Name I fS ee__ : Phone: �1Q' y.3.3-3 Sao
Reviewer/inspector Signature: Date: w/�a�
12128104 Continued

Facility Number: Date of Inspection G
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,FNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. X'es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 94-Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5P. No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LQ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PqNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EkNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EkNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
K,No
❑ NA
❑ NE
106_1�11/<t"C eyb ieu `r-Cb-rds ii : rj-r. c
12128104

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit O Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
j Facilitv \umber t
Date of Visit: -?` O'0 Time: ��
`- — - - -. Not O erational BPlnw Threshold
ermitted 0n16ertified [3 Conditionally Certified ❑ Registered Date Last Operated or Abo,-e Threshold:
Farm Name: RArd All«i TAorn�o,� FArrr, Count-: sdn 0
Owner Name: — LL�lir�7r A/lp., Thdr n70a1 Phone No:
hailing Address: 2 -2 10 rr egaer pod QZn NC_ 293 _ 8
11 CeII _W__
Facility Contact: id Ile, ZA01,4,Tithe- Phone No: ILA 3 9 s - G.232
OnsiteRepresentative: lion ,-f Ale-, D rnfo'`? Inte-grator:
Certified Operator: a M Ande"- 5 _ Operator Certification number:
Location of Farm:
a1wine ❑ Pouttry ❑ Cattle ❑ Horse Latitude 4 ` 0- Longitude ` �• ��
Design Current
Swine Canorif , Pnnnisafinn
❑ Wean to Feeder
❑-Feeder to Finish
c G
❑ Farrow to Wean
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
0 Boars
Number of Lagoons
Bolding Ponds / Solid Traps
Design Current Design Current
Poultry Ca achy Population Cattle Ca acih- lPo motion
❑ Laver F
Da'ry
❑ Non -Laver Non -Dairy
❑ Other
Total Design Capacity
r.
Total SSLW
1 ❑ Subsurface Drains Present HEILaLloonArea ICI Snrav Field Area
❑ No Li uid
item
Discharges S Stream Impacts
1. Is any discharge observed from an}' part of the operation?
Discharge originated at: ❑ Las on ❑ Spray Field ❑ Other
a- If discaarge is observed, was the convevance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notif}, DWQ)
c, if discharge is observed, what is the estimated flow in galimin?
d- Does discharge bypass a lagoon system? (if ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wage Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
r�
Freeboard (incbes):
05103107
❑ Yes e-90
❑ Yes
[ No
❑ Yes
aRo
❑ Yes
['ENO
❑ Yes
B-90
❑ Yes
9-No
❑ Yes
Eallo
Structure 6
Continued

-? 3
m�
fij/0')
AyS'M
Facility Number: `a — 2 8 3 1 Date of Inspection 0'0
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
0 Yes E3<o
❑ Yes D'No
❑ Yes 1914o
❑ Yes 0iq�o
❑ Yes LUK0
10. Are there any buffers that need maintenance/improvement? ❑ Yes '�0
15
11. is there evidence of over application? ❑ Excessive Ponding ElPAN ❑ Hydraulic Overload ElYes O go
/�
12. Crop hype Der �Q rz?
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yeses
14. a) Does the facility lack adequate acreage for land application? ❑ Yes S-No
b) Does the facility need a wettable acre determination? ❑ Yes QN-o
c) This facility is pended for a wettable acre determination? ❑ Yes ENo
15. Does the receiving crop need improvement? ❑ Yes MJW'0
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�o
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
,.,
(ie/ VA checklists, desin m {etc.)
El Yes
L� No
19.
Does record keeping need improvement? (ie < gation freeboArd�waste anal oil sample reports)
9-V�es
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q*0
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
SNO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Elwo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
QN0
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EINU-
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
. �
n wa ... __... --.
Cominenis (refeTto question E><platn any YEanswers arid/ur..snv recommendations or+any ather comments.
4 ., .. .,
€Use drawutgs of i—Arty to better explain sEtuat�ons. (use tidd�donal pages as necessary) ; 1eld Cony ❑ Final Notes
19. /III. The.'?TOiI �US
Mr. pvr Qa,��� f�c'/i.,g Iris IPGnlIOe�g %ECorc�s: �/. 7ryC��/a.�
bus ne1L Cer./+Ie�Po% �.s /2R
F�r�.s e'er Nevr_,je,- JC0 `#,& G us t•+CavP�y� �C 9�✓� Mr,
C{a:%fY lie �v.s�P;n9 1�r7'br��
�.,rGrrtuY.'o.i mo/� aIle, I "^s//wol d� woy'�.:yi v��.'/ ¢,t,.
f t'050ff was over. T e
le5l rtea,4 �'oe /t'1�y -7de3 s4o4.Pr/ tl„� Mr, 7,4h,, ,j
17Ffc/s t0 arI,me 10
jj�Sod
ryes Y ,,&IeI4,
4,,4bogu,w.,
ftie / co,c
Reviewer/Inspector Name
=}
Re-tiewer/Inspector Signature:
Date: 3 - 70- a y
05103101
or
Continued

I VT
Site Requires Immediate Attention:
Facility No. $'z' zz'3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 27 /V , 1995
Time:
Farm Name/Owner:_ 7'FodE r �5'//��✓ /h`G
Mailing Address: R71- 3 dox /!00
County:
Integrator: R -N21�
On Site Representative:
Physical Address/Location:
Phone: fla -
u
P _V
Type of Operation: Swine IX- Poultry Cattle
Design Capacity: 2SD Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) r No Actual Freeboard: 1� Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or T�o Was any erosion observed? Yes o�
Is adequate land available for spray? e r No Is the cover crop adequate?Cor No
Crop(s) being utilized: -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? <ia or No
100 Feet from Wells? �Oor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or to -
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oRIZ If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes orog) S ,. ll
Additional Comments: Nar
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.